Diabetes mellitus arrhythmia

To reduce mortality, administration of an aldosterone antagonist, either eplerenone or spironolactone, should be considered within the first 2 weeks following MI in all patients who are already receiving an ACE inhibitor (or ARB) and have an EF of equal to or less than 40% and either heart failure symptoms or diagnosis of diabetes mellitus.3 Aldosterone plays an important role in heart failure and in MI because it promotes vascular and myocardial fibrosis, endothelial dysfunction, hypertension, left ventricular hypertrophy, sodium retention, potassium and magnesium loss, and arrhythmias. Aldosterone antagonists have been shown in experimental and human studies to attenuate these adverse effects.70 Spironolactone decreases all-cause mortality in patients with stable, severe heart failure.71... 

For pentamidine, side effects include hypotension, tachycardia, nausea, vomiting, severe hypoglycemia or hyperglycemia, pancreatitis, irreversible diabetes mellitus, elevated transaminases, nephrotoxicity, leukopenia, and cardiac arrhythmias. 

Unlabeled Uses Treatment of pralidoxime-induced hypertension, arrhythmias, asthma, bladder instability, cardiac diseases, diabetes mellitus, erectile dysfunction, extravasation (dopamine and epinephrine), hyperhidrosis, myocardial infarction, Raynaud s phenomenon, surgery, sympathetic pain... 

Amiloride is used with thiazide or loop diuretics in hypertension, in congestive heart failure, in digitalis-induced hypokalemia, and in arrhythmias resulting from hypokalemia. Inappropriate use of amiloride may cause hyperkalemia (potassium >5.5 mEq/L), which may be fatal if not corrected, and may be more deleterious in elderly individuals and in patients with diabetes mellitus and renal impairment. The symptoms of hyperkalemia include fatigue, flaccid paralysis of the extremities, paresthesias, bradycardia, ECG abnormalities, and shock. Amiloride is not metabolized but is contraindicated in anuria, acute or chronic renal insufficiency, or in diabetic nephropathy. It should not be used with potassium preparations, and should be used cautiously with ACE inhibitors because these agents cause hyperkalemia. 

Ritodrine is contraindicated in antepartnm hemorrhage, which demands immediate delivery eclampsia and severe preeclampsia intrauterine fetal death chorioamnionitis maternal cardiac disease pulmonary hypertension maternal hyperthyroidism and uncontrolled maternal diabetes mellitus. Overdosage with ritodrine may canse tachycardia (maternal and fetal), palpitations, cardiac arrhythmia, hypotension, dyspnea, nervousness, tremor, nansea, and vomiting. 

Sotalol should be used cautiously in pregnant patients and patients with renal failure or diabetes mellitus. Sotalol should be used with extreme caution in patients with sick-sinus syndrome associated with symptomatic arrhythmias, because the drug can cause sinus bradycardia, sinus pauses, or sinus arrest. 

OnodaN, Kawagoe M, Shimizu M, Komori T, Takahashi C, Oomori Y, Hirata Y. A case of non-insulin dependent diabetes mellitus whose insulin requirement was m kedly reduced after disopyramide treatment for arrhythmia. Nippon Naika Gakkai Zas i (1989) 78, 820-5. 

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