Bedside recognizing diabetics with or without CHD real risk or silent CHD.
Sergio Stagnaro, Biophysical Semeiotics Research Laboratory
14 November 2006
Sirs,
All authors must agree with such as statemente “Diabetes is an important predictor of mortality patients with ACS”. However, on the base of my clinical biophysical-semeiotic data, we have to divide diabetics with CHD in two categories: on the one hand, diabetic patients involved also by coronary endothelial dysfunction, evaluated bedside in “quantitative” way, and diabetics without impairement of coronary endothel function, showing physiological, type I preconditioning, i.e., normal blood-flow through nutritional capillaries of heart vessels (1-6).
The presence of subclinical disease substantially increases the risk of subsequent CHD for individuals with hypertension, diabetes mellitus, or elevated C-reactive protein. Notoriously, subclinical, and consequently dangerous, coronary heart disease is very prevalent among older individuals, is independently associated with risk of CHD , and substantially increases the risk of CHD among individuals with hypertension and/or diabetes mellitus. In following, I suggest - once again - an useful, reliable and easy clinical manoeuvre, that allows doctor to recognize both CHD Real Risk and silent CHD (1-6).
This clinical procedure proved to be really useful in my 50-year-long clinical experience, also in order to the bed-side recognizing heart ischaemic disease before cardiac pathology occurs, especially in diabetics, since the initial stage. Moreover, it is well known that patients with coronary artery disease (CHD) may have no symptoms at all for many years or decades and that the electrocardiographic features of ischaemia may be induced by exercise without accompaning angina (1). (For further information, See web site http://www.semeioticabiofisica.it, Practical Applications).
In other words, we need a clinical tool reliable in rapid detecting CHD, even clinically silent, initiating from CHD “real risk”, doctor can now utilize in his day-to-day practice (1-6).
I think surely that one method is "Myocardial Ischaemic Biophysical-Semeiotic Preconditioning", described elsewhere(1-3). From the tehnical viewpoint, doctor has to know, at least, the auscultatory percussion of the stomach, described even in old acàdemic books of two last centuries (2). Briefly, in healthy individuals, digital pressure of mean intensity, applied upon heart cutaneous projection area, brings about the so-called gastric aspecific reflex (= in the stomach, fundus and body are dilated; on the contrary, antral-pyloric region contracts) after an age-dependent latency time of 8 sec., that lasts less than 4 sec. (= parameter value of paramount significance since it parallels the efficicacy of coronary microvessel Microcirculatory Funcional Reserve, myocardial oxygenation and then the absence of newborn-pathological Endoarterial Blocking Devices in coronary small arteries, according to Hammersen (2, 4, 5).
A second, successive evaluation after an interval of 5 sec. exactly, provokes the identical reflex, but after lt. of 14 sec. or more: physiological myocardial preconditioning, typeI.
On the contrary, in patients involved by CHD, even silent, i.e. subclinical, with or without diabetes, latency time persists identical in both evaluations, or results clearly lower in the second one, in relation with disease seriousness: type II and, respectively, type III preconditioning.
Of course, biophysical semeiotic preconditioning evaluation, really more complex than it appears in the above brief description, can be applied to all others biological systems, with favourable influences on primary prevention and diagnosis (1-5).
1) Stagnaro-Neri M., Stagnaro S. Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of Ischaeemic Heart Disease even silent. Acta Medica Mediterranea 13, 109-116, 1997.
2) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm
3) Stagnaro S. A clinical efficacious maneouvre, reliable in bed-side diagnosing coronary artery disease, even initial or silent, as well as "heart coronary risk". 3rd Virtual International Congress of Cardiology, FAC,2003, http://www.fac.org.ar/tcvc/marcoesp/marcos.htm
4) Stagnaro S. Hypertensive Constitution accounts for the exsistence of diabetics with and without Hypertension. Cardiovascular Diabetology 2006, 5:19 doi:10.1186/1475-2840-5-19
5) Stagnaro Sergio Endothelial cell function can ameliorate under safer drugs, such as Melatonin-Adenosine. BMC Cardiovascular disorders. 2004 http://www.biomedcentral.com/1471-2261/4/4/comments
6) Stagnaro S. Pre-Metabolic Syndrome: Locus primary prevention. NYAS web site. 1999 http://www.memberconnections.com/olc/membersonly/NYAS/mboards.html
Bedside recognizing diabetics with or without CHD real risk or silent CHD.
14 November 2006
Sirs,
All authors must agree with such as statemente “Diabetes is an important predictor of mortality patients with ACS”. However, on the base of my clinical biophysical-semeiotic data, we have to divide diabetics with CHD in two categories: on the one hand, diabetic patients involved also by coronary endothelial dysfunction, evaluated bedside in “quantitative” way, and diabetics without impairement of coronary endothel function, showing physiological, type I preconditioning, i.e., normal blood-flow through nutritional capillaries of heart vessels (1-6).
The presence of subclinical disease substantially increases the risk of subsequent CHD for individuals with hypertension, diabetes mellitus, or elevated C-reactive protein. Notoriously, subclinical, and consequently dangerous, coronary heart disease is very prevalent among older individuals, is independently associated with risk of CHD , and substantially increases the risk of CHD among individuals with hypertension and/or diabetes mellitus. In following, I suggest - once again - an useful, reliable and easy clinical manoeuvre, that allows doctor to recognize both CHD Real Risk and silent CHD (1-6).
This clinical procedure proved to be really useful in my 50-year-long clinical experience, also in order to the bed-side recognizing heart ischaemic disease before cardiac pathology occurs, especially in diabetics, since the initial stage. Moreover, it is well known that patients with coronary artery disease (CHD) may have no symptoms at all for many years or decades and that the electrocardiographic features of ischaemia may be induced by exercise without accompaning angina (1). (For further information, See web site http://www.semeioticabiofisica.it, Practical Applications).
In other words, we need a clinical tool reliable in rapid detecting CHD, even clinically silent, initiating from CHD “real risk”, doctor can now utilize in his day-to-day practice (1-6).
I think surely that one method is "Myocardial Ischaemic Biophysical-Semeiotic Preconditioning", described elsewhere(1-3). From the tehnical viewpoint, doctor has to know, at least, the auscultatory percussion of the stomach, described even in old acàdemic books of two last centuries (2). Briefly, in healthy individuals, digital pressure of mean intensity, applied upon heart cutaneous projection area, brings about the so-called gastric aspecific reflex (= in the stomach, fundus and body are dilated; on the contrary, antral-pyloric region contracts) after an age-dependent latency time of 8 sec., that lasts less than 4 sec. (= parameter value of paramount significance since it parallels the efficicacy of coronary microvessel Microcirculatory Funcional Reserve, myocardial oxygenation and then the absence of newborn-pathological Endoarterial Blocking Devices in coronary small arteries, according to Hammersen (2, 4, 5).
A second, successive evaluation after an interval of 5 sec. exactly, provokes the identical reflex, but after lt. of 14 sec. or more: physiological myocardial preconditioning, typeI.
On the contrary, in patients involved by CHD, even silent, i.e. subclinical, with or without diabetes, latency time persists identical in both evaluations, or results clearly lower in the second one, in relation with disease seriousness: type II and, respectively, type III preconditioning.
Of course, biophysical semeiotic preconditioning evaluation, really more complex than it appears in the above brief description, can be applied to all others biological systems, with favourable influences on primary prevention and diagnosis (1-5).
1) Stagnaro-Neri M., Stagnaro S. Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of Ischaeemic Heart Disease even silent. Acta Medica Mediterranea 13, 109-116, 1997.
2) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm
3) Stagnaro S. A clinical efficacious maneouvre, reliable in bed-side diagnosing coronary artery disease, even initial or silent, as well as "heart coronary risk". 3rd Virtual International Congress of Cardiology, FAC,2003, http://www.fac.org.ar/tcvc/marcoesp/marcos.htm
4) Stagnaro S. Hypertensive Constitution accounts for the exsistence of diabetics with and without Hypertension. Cardiovascular Diabetology 2006, 5:19 doi:10.1186/1475-2840-5-19
5) Stagnaro Sergio Endothelial cell function can ameliorate under safer drugs, such as Melatonin-Adenosine. BMC Cardiovascular disorders. 2004 http://www.biomedcentral.com/1471-2261/4/4/comments
6) Stagnaro S. Pre-Metabolic Syndrome: Locus primary prevention. NYAS web site. 1999 http://www.memberconnections.com/olc/membersonly/NYAS/mboards.html
Competing interests
None declared