What are the most likely complications for pregnant women with vascular disease?

Diabetic vascular disease is divided into two categories: diabetic macrovascular disease and diabetic microvascular disease. The main symptoms of diabetic vascular disease include dizziness, headache, chest tightness, lower limb edema and paralysis, feeling weak and tired when walking, etc. There are also many complications of vascular disease, such as kidney disease, blindness, paralysis, myocardial infarction, etc.

Classification of diabetic vascular disease

1. Diabetes complicated by large vessel disease: Diabetic patients are more likely to develop atherosclerosis than normal people, and it develops rapidly, leading to coronary heart disease, cerebrovascular accident and lower limb gangrene. It is reported that 20% of patients who had peripheral vascular disease in the past were found to have diabetes, and the incidence of intermittent claudication, muscle and skin atrophy, and lower limb gangrene in diabetic patients was also higher than that in normal people. Therefore, patients confirmed to have peripheral vascular disease should be further examined to see if they have diabetes. It is currently believed that the occurrence of macrovascular disease is related to the patient's age, the course of diabetes and the degree of diabetes control.

2. Diabetic microvascular disease: The main sites of microvascular disease in diabetic patients are the microvessels in the retina, kidneys, skin, etc. The main pathological changes are the thickening of the capillary basement membrane. Retinal microvascular disease is common in patients with juvenile-onset diabetes and is the main cause of blindness in the future. Diabetic nephropathy often coexists with diabetic retinopathy and diabetic neuropathy. Diabetic skin microvascular disease can be seen in any part of the body, but it is more common to involve the skin microvessels in the anterior tibia and feet of the lower limbs, resulting in local cyanosis and skin ischemic ulcers. The ulcer is superficial and painful, with good dorsalis pedis artery pulsation.

Clinical manifestations

1. Symptoms and Signs

(1) Hypertension may cause dizziness and headache, but some patients are asymptomatic and are only discovered during physical examination. However, other causes of high blood pressure should be ruled out, such as pheochromocytoma, primary aldosteronism, hypercortisolism, glomerulonephritis, etc.

(ii) Cardiac symptoms may include chest tightness, shortness of breath after activity, angina pectoris, and in severe cases, heart failure, myocardial infarction, arrhythmia, and even sudden death. The heart border may be enlarged, the heart rate may increase or become fixed, the heart sounds may be low and dull, and symptoms of heart failure may appear: distension of the jugular veins, orthopnea, cyanosis of the lips, hepatosplenomegaly, and lower limb edema.

(3) The brain may have localizing signs such as aphasia, mental changes, limb paralysis, etc., and accompanied by brain atrophy, it may manifest as decreased intelligence, poor memory, slow reaction, etc. Cerebrovascular diseases may present with localizing signs and changes in mental status.

(iv) The lower limbs may experience coldness, weakness, drowsiness, inability to walk for long periods of time, and increased fatigue when walking, which disappears after resting for 2 to 3 minutes. Intermittent claudication may occur later. After walking for a while, there is soreness and cramping pain in the calf gastrocnemius and feet. If you continue walking, the disease will get worse, and you will be forced to stop, or the pain will be relieved after a short rest. As the disease progresses, rest pain and limb pain may occur, which may persist or intermittently worsen when the patient is resting. In severe cases, persistent pain and paresthesia may occur during the night and day. The skin temperature of the affected lower limbs may decrease, the skin color may change, the arterial pulsation may weaken or disappear, and the lower limbs may ulcerate and necrotize.

What complications does diabetic vascular disease cause?

Myocardial infarction: The risk of myocardial infarction in people with diabetes and hypertension is 4 times higher than that in people without diabetes. The risk of myocardial infarction in people with diabetes and hypertension is significantly higher than that in people without diabetes. Diabetic patients may also have specific microvascular lesions, which may appear 8-20 years before the onset of diabetes. This specific microvascular lesion can promote the occurrence of coronary heart disease and myocardial infarction. Diabetic patients should pay special attention to the fact that the symptoms of hypoglycemia are similar to those of a heart attack, with symptoms such as panic and heart palpitations. Hypoglycemia also causes weakness all over the body and cold sweats on the back. Both of these are sudden emergencies. Clearly identifying the cause is of great significance to saving the patient's life.

Stroke: lesions in cerebral blood vessels can lead to two major types of stroke: cerebral hemorrhage and cerebral infarction. Cerebral hemorrhage directly endangers life, and cerebral infarction, even with timely rescue, can leave sequelae such as paraplegia, aphasia, hemiplegia, slow reaction, etc., which seriously affect the quality of life of diabetic patients. It is particularly important to note that once a stroke occurs, the recurrence rate is as high as over 70%, which is undoubtedly a further blow to the vast majority of diabetic patients.

Kidney disease: Kidney disease is a common complication of diabetes, with an incidence rate as high as 65%, and is one of the main causes of death in diabetic patients. Diabetic nephropathy accounts for the first place in end-stage renal failure, accounting for about 35%-38%. Among patients with renal failure undergoing dialysis, 70%-80% of cases are caused by diabetes. Patients with early diabetic nephropathy have foam in their urine, accompanied by mild back pain, swelling of the lower limbs, and a depression when pressed with the hand. If discovered early, reversal treatment can be performed. Once it enters the middle and late stages, life can only be maintained by dialysis and kidney transplantation.

Blindness: Diabetic vascular disease can lead to diabetic retinopathy, cataracts, glaucoma and age-related macular degeneration, which are eye diseases that directly endanger vision. Early diagnosis, control of retinal vascular disease and visual protection are the key to reducing visual damage. Unfortunately, 50% of diabetic patients are unaware of their condition. In the early stages, they feel floaters in front of their eyes, which gradually develop into blurred and distorted vision. Once they feel that their vision is significantly impaired, they can only undergo terminal treatment and the condition cannot be reversed.

Neuropathy: The occurrence of neuropathy in diabetic patients is related not only to vascular disease but also to the intake and metabolic disorders of neuronutrients such as vitamins. Neuropathy can cause itching and tingling of the patient's skin, numbness and loss of sensation in the limbs. The treatment of neuropathy is complicated, and there is no clear staging yet. Symptoms can be relieved through relevant drugs and physical therapy, but it is often difficult to cure. In particular, various types of nerve pain caused by neuropathy, such as needle pricks and burns, make patients miserable.

Sexual dysfunction: Microvascular disease and neuropathy can jointly lead to sexual dysfunction in men and women, with erectile dysfunction in men and sexual apathy in women. When some male diabetic patients encounter such problems, they should first start with controlling blood sugar and treating vascular disease. Simply treating it according to andrological methods will not only be of no help, but will also delay the disease.

Diabetic foot: Lower limb venous thrombosis and endothelial thickening can lead to narrowing of the vascular lumen and insufficient blood supply to the patient's feet, resulting in cold feet and shiny and thin skin. At the same time, acroneuropathy can occur, leading to loss of sensation in the patient's lower limbs and feet. The patient has no feeling of acupuncture or burns, and can easily lead to traumatic infection. About 85% of diabetic patients have foot ulcers before amputation, 50%-70% of diabetic patients have gangrene during amputation, and 20%-50% have concurrent infections. Once amputation occurs, it is difficult for the patient to survive for more than 5-7 years. Only early detection and early treatment can avoid serious consequences such as amputation.