Pathophysiology Causes of Dysphoe in Patients with Chronic Obstructive Pulmonary Disease and Diabetes Melitus

Such a nonspecific complaint as breathlessness with minimal physical exertion can potentially be associated with both pulmonary pathology and heart failure, as well as ischemic heart disease. The latter variant is often observed in patients with diabetes mellitus, where due to diabetic neuropathy, the patient does not suffer from typical angina but has its equivalent in the form of dyspnea. Objective — to study the prevalence of ischemic heart disease due to stenosing atherosclerosis of the coronary vessels and microvascular angina, as well as heart failure with preserved ejection fraction in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus. Materials and methods. The study retrospectively included 62 patients with type 2 diabetes mellitus and COPD who complained of exertional dyspnea. Upon examination, 21.0 % of these patients were found to have and underwent percutaneous coronary intervention (PCI) for stenosing atherosclerosis of the coronary arteries, 21.0 % were diagnosed with microvascular angina, and 62.9 % with heart failure with preserved left ventricular ejection fraction, and their therapy was accordingly modified. Thanks to this comprehensive approach, the mean results of the 6-minute walk test changed from an initial (156.6 ± 16.5) to (356.9 ± 31.1) m after 12 months of observation (p < 0.05). Results and discussion. Over the course of 12 months, diabetes compensation (HbA1c < 7.0 %) was achieved in 55 (88.7 %) patients. Body mass index reduction to less than 30 kg/m2 during the observation period was recorded in 12 (85.7 %) of 14 obese patients. In 13 of 26 (41.9 %) patients with stress-echo confirmed myocardial ischemia but no significant lesions in coronary arteries according to CT coronary angiography, the coronary flow reserve index was less than 2. With comprehensive treatment of comorbid pathology, the mean 6-minute walk test results after 12 months significantly differed from the baseline and even from the 1-month values (356.9 ± 31.1) vs. (156.6 ± 16.5) and (234.2 ± 21.8) meters, respectively, p < 0.05). Conclusions. A comprehensive approach to patients with diabetes and exertional dyspnea, considering the possibility of having COPD, ischemic heart disease, and heart failure, and treating these conditions accordingly, allows achieving maximum effect in terms of increasing the functional capacity of patients.