Takotsubo cardiomyopathy shortly following pacemaker implantation-case report and review of the literature.

We describe a patient with acute heart failure shortly after pacemaker implantation. With the documentation of typical dyskinesia of the apical segments with hyperdynamic contractility of the basal segments and a normal coronary angiogram, pacemaker implantation-induced Takotsubo cardiomyopathy was diagnosed. Supportive care was administered and within several days the patient's symptoms resolved. After several weeks, the left ventricular function had fully recovered. A review of the literature on Takotsubo cardiomyopathy after pacemaker implantation is presented.

[Treatment of patients with diabetes mellitus type 2 and coronary artery disease]. / Behandeling van patiënten met diabetes mellitus type 2 en tevens coronaire hartziekten.

Of all patients presenting with coronary, artery disease, 20-30% already have a diagnosis of diabetes mellitus type 2. Of the remaining patients, another 15-20% are found at presentation to have diabetes mellitus and 30% have glucose intolerance. Both conditions are major risk factors for the recurrence of coronary artery disease and mortality. The treatment of patients with diabetes mellitus type 2 always includes improvement in lifestyle, adequate blood-glucose control, cholesterol-lowering therapy and blood-pressure control. Furthermore, if one or more other traditional cardiovascular risk factors are present, or if the patient is over 40 years of age, acetylsalicylic acid must be added. Finally, with a prior history of coronary-artery disease, patients must be given an angiotensin converting enzyme (ACE) inhibitor. During percutaneous coronary interventions, patients with diabetes mellitus type 2 are preferably treated with a drug-eluting stent in combination with clopidogrel, and in case of an acute coronary syndrome, glycoprotein (GP) IIb/IIIa receptor antagonists are added to the standard treatment.

Cardiac complications in type 2 diabetic patients with mild anginal symptoms and documented reversible myocardial perfusion defects: Results of the MERIDIAN trial.

BACKGROUND/OBJECTIVE: To compare early invasive treatment with continued pharmacological treatment in patients with diabetes mellitus type 2, mild anginal symptoms and documented myocardial ischaemia. METHODS: Patients with type 2 diabetes mellitus and mild anginal symptoms underwent myocardial perfusion scintigraphy (MPS). Patients with myocardial ischaemia were randomly assigned to early invasive or continued pharmacological treatment. All patients were followed for the occurrence of MACE (death, nonfatal myocardial infarction or hospitalisation for unstable angina pectoris). RESULTS: A total of 156 patients were randomised when the sponsor (ZonMW) prematurely terminated the study because of a slow recruitment rate. With a mean follow-up of 2.1±0.6 years, 9 of 79 patients assigned to early invasive treatment developed MACE compared with 10 of 77 patients randomised to continued pharmacological treatment, annual event rate 5.4 vs. 6.3%, hazard ratio 0.89, 95% CI 0.36 to 2.20, p=0.34. Due to the limited number of included patients and the low event rate, the study did not have sufficient power for the study objective. CONCLUSION: Patients with diabetes mellitus type 2, mild anginal symptoms and documented myocardial ischaemia, under appropriate medical treatment, have a lower than anticipated annual event rate of MACE of ±5 to 6% which questions the beneficial effect of early revascularisation.