Diabetics’ Symptoms
Diabetics tend to have atypical symptoms of heart disease. Longstanding diabetes causes nerve damage (neuropathy). The damaged nerves may include those that transmit information on pain. If you are diabetic it’s important to recognize even minor symptoms. Your symptoms of a heart attack may be limited to fatigue, nausea, and shortness of breath.
Diagnosis Without Symptoms
It’s difficult for a doctor to make a diagnosis if you don’t have any complaints. Doctors thus suspect coronary artery disease -- known as CAD -- in all diabetics due to the enormously increased risk in this population. Aggressive management of cardiac risk factors such as control of blood sugar, cholesterol, and blood pressure takes on an even more important role in those with diabetes. Indeed, the target levels of "ideal" cholesterol and blood pressure levels are lower in diabetics than in the general population. Aspirin and cholesterol lowering statin medication is often prescribed to diabetics even if there is no documented CAD.
As noted above, the symptoms of CAD in diabetics can be atypical, or different from the classical "Hollywood heart attack." All diabetics are thus considered candidates for aggressive lifestyle modification along with aspirin and statin therapy. This approach can substantially reduce a diabetic's risk of a heart attack. Doctors may also recommend non-invasive testing of CAD.
Tests that can diagnose and predict CAD include the ECG (electrocardiogram), echocardiogram, stress test, high-speed CTA scan, and certain blood tests such as cholesterol level and CRP (c-reactive protein).
Unfortunately, no test can predict a heart attack with 100% accuracy. All patients with diabetes should focus on CAD risk factors regardless of test results.
The bottom line is that when you're diabetic the risk of CAD and heart attacks is high and symptoms are unreliable. But, there is still a lot you and your doctor can do to prevent heart attacks.