A patient with advanced diabetes and autonomic neuropathy may not show the typical clinical findings following an acute myocardial infarction (AMI). A high index of suspicion may be needed to diagnose a heart attack in these patients.


A patient with diabetic cardiovascular autonomic neuropathy who has had an acute myocardial infarction may present with:

(1) nothing (clinically silent)

(2) nausea and vomiting

(3) cough or dyspnea

(4) fatigue or tiredness

(5) seemingly minor pain (associated with an altered pain threshold)


The presence of an AMI may be detected by:

(1) changes in the electrocardiogram

(2) changes in serum markers such as troponin


The person may present with heart failure associated with previous ischemic episodes.


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