Diastolic heart failure treated by diet

Deutsche medizinische Wochenschrift
Peter Heilmeyer, Helene von Bibra

Abstract

History and admission findings | An obese patient with type 2 diabetes (on 90 IU insulin daily) and exertional dyspnoea (NYHA II-III) for 3 weeks presented in a rehabilitation clinic hoping to reduce his weight. Clinical and laboratory findings excluded any inflammatory or systemic disease apart from diabetes mellitus. Blood pressure and serum lipid levels were normal. Investigations | An unremarkable ECG stress test and echocardiogram excluded ischemic and hypertensive heart disease and primary cardiomyopathy. Pulsed tissue Doppler revealed diastolic cardiac dysfunction. Unremarkable were also chest X-ray, pulmonary function testing and 24-hour ECG. Treatment and Course | The findings supported the diagnosis of HFpEF and diabetic/insulin resistance cardiomyopathy. Insulin resistance was treated for three weeks by low-carbohydrate nutrition and moderate exercise. At discharge, weight was reduced by 2 kg, exercise capacity and diastolic function were normalized, as were insulin resistance and postprandial glucose levels, whilst antidiabetic therapy was reduced to low-carbohydrate nutrition. Conclusion | HFpEF due to insulin resistance cardiomyopathy is often not recognized, especially in obese individuals, and may be further agg...Continue Reading

Citations

Apr 14, 2016·MMW Fortschritte der Medizin·Thorsten Siegmund
Oct 21, 2016·Current Heart Failure Reports·Helene von BibraMartin St John Sutton

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