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Harrison's Principles of Internal Medicine, 18e
| Part 10. Disorders of the Cardiovascular System > Section 4. Disorders of the Heart > |
Chapter e31. Cardiac Manifestations of Systemic Disease
Sections: Cardiac Manifestations of Systemic Disease: Introduction, Further Readings.
Topics Discussed: cardiovascular finding; systemic disease.
Excerpt:"The common systemic disorders that have associated cardiac manifestations are summarized in Table e31-1.(See also Chap. 344) Diabetes mellitus, both insulin- and non-insulin-dependent, is an independent risk factor for coronary artery disease (CAD; Chap. 241) and accounts for 14–50% of new cases of cardiovascular disease. Furthermore, CAD is the most common cause of death in adults with diabetes mellitus. In the diabetic population the incidence of CAD relates to the duration of diabetes and the level of glycemic control, and its pathogenesis involves endothelial dysfunction, increased lipoprotein peroxidation, increased inflammation, a prothrombotic state, and associated metabolic abnormalities.(See also Chap. 75) In patients whose intake of protein, calories, or both is severely deficient, the heart may become thin, pale, and hypokinetic with myofibrillar atrophy and interstitial edema. The systolic pressure and cardiac output fall, and the pulse pressure narrows. Generalized edema is common and relates to a variety of factors, including reduced serum oncotic pressure and myocardial dysfunction. Such profound states of protein and calorie malnutrition, termed kwashiorkor and marasmus, respectively, are most common..."
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