Cardiovascular System - DM2


  • DM2-related cardiac pathophysiology, although affecting all myocardial tissue, preferentially targets the cardiac conduction system. Conduction system defects are progressive and, while initially asymptomatic, increase the risk for symptomatic arrhythmias.

  • Pre-syncope, syncope, palpitations, dyspnea, chest pain or sudden death from cardiac arrest.

  • Risk of both bradyarrhythmias and tachyarrhythmias. The most common tachyarrhythmias are atrial fibrillation and atrial flutter, which pose a risk of cardiogenic embolism and stroke. There is an increased risk of ventricular tachyarrhythmias (tachycardia or fibrillation), a mechanism responsible for cardiac arrest, in DM2.

  • Asymptomatic abnormalities are observed in a moderate number of adults with DM2 and are more common in those with conduction system disease.


  • Palpitations, pre-syncope, syncope, dyspnea and chest pain; if observed, seek prompt attention.

  • Arrhythmias including sinus bradycardia, heart block, atrial fibrillation and flutter, and ventricular tachycardia.

  • Symptom change, abnormal cardiac imaging (MRI or echocardiogram), abnormal ECG.


  • Discuss the following tests with your doctor:

    • Cardiac testing, including the 12-lead electrocardiogram (ECG), long-term ambulatory Holter-ECG monitoring and invasive electrophysiological study.

    • Imaging studies, including echocardiography, magnetic resonance (MR), and nuclear imaging to assess the heart’s mechanical status, including left ventricular function.

    • Impulse or conduction abnormalities on a standard 12-lead ECG.

    • Echocardiography and cardiac MRI if abnormal ECG or other symptoms suggestive of heart failure are present.


  • Pacemakers can be implanted either to treat symptomatic bradyarrhythmias or prophylactically in those at high risk for complete heart block.

  • Implantable cardioverter-defibrillators (ICDs) can be installed for ventricular tachyarrhythmia, or prophylactically in those at high risk for a ventricular tachyarrhythmia.

  • Use of emergency medical alert devices.

  • Serial periodic clinical cardiology evaluations; cardiology consultations are recommended in for abnormal electrocardiograms and/or cardiac symptoms.

  • Cardiac imaging at diagnosis and every three to five years thereafter.

  • Invasive electrophysiology when there is concern about a serious conduction block or arrhythmia because of abnormalities detected via noninvasive cardiac testing.

  • Ambulatory Holter ECG monitoring – either short-term (24-48 hours) or long-term (30 days or more) may be considered to detect mechanisms of arrhythmias.

  • Refer to:

    • A cardiology center experienced in care of DM2

    • An anesthesia practitioner, separate from the operating physician, to provide procedural sedation and monitoring for electrophysiology studies and pacemaker or ICD implantation.