Conservative treatment for acute coronary syndrome in patients with type 2 diabetes mellitus

2 diabetes mellitus (T2DM). Dyspnea during physical exertion should be considered an anginal equivalent in patients with T2DM, and suffocation causing admission to ICU ? as a possible sign of myocardial infarction. Proximal and distal coronary lesions combined with diabetic microangiopathy compromising collateral circulation are a frequent finding in these patients. Therefore an infusion of nitroglycerine may yield a rapid improvement in their condition. Treatment with low-molecular-weight heparin (LMWH) should be administered for a longer period due to rheological disturbances in T2DM. Diabetic patients with a history of myocardial infarction (MI) should receive a life-long therapeutic combination of two different antiplatelet agents. Carvedilol, a non-selective beta blocker/ alpha-1 blocker, and selective beta-1 blockers (e.g. nebivolol, bisoprolol) have better safety profile than other beta blockers concerning neurological aspects of hypoglycemic events.

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