Diabetic patients may experience symptoms caused by CHD in the same way as non-diabetic patients. Other symptoms attributable to obstructive CHD include breathlessness, manifesting as 'angina-equivalent', and ischaemia-related left ventricular dysfunction. Palpitations, presyncope and syncope may arise because of ischaemia-related arrhythmia, such as atrial fibrillation/flutter, and ventricular arrhythmia, including ectopy and tachycardia. A characteristic feature of diabetes is the absence or muted intensity of angina. This 'silent ischaemia' is partly related to diabetic autonomic neuropathy (Findlay, 2003). The prognosis of patients with 'silent ischaemia', as evidenced by ischaemic changes on an electrocardiogram (ECG) on exercise testing without symptoms and good prognostic features, is similar to those with symptomatic angina (Lotan etal., 1994; Marwick, 1995).
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