The ECG Vertigo in Diabetes and Cardiac Autonomic Neuropathy
Figure 1
A 45-year-old man underwent routine blood tests that revealed a fasting blood glucose value of 125 mg/dL and hemoglobin A1c of 6.5%, resulting in the diagnosis of type 2 diabetes. Resting 12-lead ECG showed deep S-wave in Lead III and R-wave in Lead aVL, indicating early left ventricular hypertrophy. Cardiac autonomic functional testing diagnosed the presence of cardiac autonomic neuropathy. Stress ECG demonstrated a 2-mm depression of the ST segment. Transthoracic 2D Doppler echocardiography performed revealed presence of mild left ventricular (LV) hypertrophy (LV wall mass index = 126 g/m2) and an abnormal relaxation pattern (E/A < 1) with preserved LV systolic function (LV ejection fraction >60%). The patient was given strict diet restrictions; oral antidiabetic medication, b-blocker, statin and aspirin therapy was initiated, together with lifestyle measures to control cardiovascular risk factors. Throughout a 6-year follow-up, his diabetes remains well controlled, and the ECG unchanged.
