What lies in me

Hi, I'm Nino. 

I'm male 38 years old (in October 2013), has diabetics type 2 and have a heart condition called Ischemic Dilated Cardio Myopathy (IDCM), would be a quite deadly combination don't u think ?.  I m marriage with Shirlie who is 2 years younger than me, and have an 8 years old son. I'm not a doctor. But as a patient, i am sure i have the right to speak up my own perspective of this illness.

There are millions of people in the world who has not realized about what has started inside their heart/cardiac.  

Hopefully they somehow read my story......

Dilated Cardiomyopathy

The symptoms starts at mid 2011 when i had a holiday trip with my family.  But human usually being late before finally the damage is done. So that,  If any of you has, one time, felt abnormal exhaustion even only in view second after you walk for less of 100 m.  Please check up yourself not only using ECG  My precondition as a diabetic type-2 since 2002 certainly become a major acceleration of the IDCM, even when i always in good control of my blood-sugar level. 

IMPORTANT : check your Cardiac using ECHO CARDIO GRAM and not ELECTRO CARDIO GRAM only.  

Echocardiogram
Intervention
This is an example of an abnormal mid-muscular ventricular septal flaw.

Most of the doctor only use Electrocardiogram until something serious happen, which is a heart-dilation.

Basically IDCM is a condition where the heart is enlarged and weakened the cardiac pump action until it zero and stop completely.  This is one of the silent killer beside high-blood pressure and diabetics itself.  It can happen to anybody slim or fat, athletics or nerd in all the way, male or female, or any of unthinkable.  And when your cardiac fail to efficiently pump the blood in your vessel, many organs will start to deteriorate as well, such as kidney, lever, pancreatic, nerve system, etc.  

It is not kind of heart-stroke (cerebro-vascular accident) which happen accompanying the sudden high blood pressure syndrome, neither cardiovascular clogging, or coronary condition, IDCM results the the opposite symptoms of low blood pressure (left ventricle enlargement), so for anybody with obesity but have kind of "normal" blood pressure 120/80 or even lower, you may think of something for precaution.  I mean, naturally obesity make blood pressure a bit higher than normal, so when you find that your blood pressure even lower than normal, perhaps it is a starting symptom of the weakening of heart pumping capability. 

So what cause IDCM literally ? Since it comes with word "ischemic", I consider it more mystical for me hahaha. But these are several factors : 

1. continuous fatigue with less recovery

2. less and/or bad quality of sleeping in long term continuously

3. prolonged stress/depression

4. undetected virus/bacterial (trypanosoma cruzi, etc)

5. cardiovascular condition due to uncontrolled diabetics

6. Alcohol consumption 

7. Thyroid diseased 

8. Pregnancy (this one is usually reversible)

9. Autoimmune mechanism

10. Genetics (About 25–35% of patients have familial forms of the disease)

I rather not mention : "not to smoke" to one of the above factors, because smoking perhaps is not directly caused IDCM, but it leads you to another deadly door step for sure.  Which are lung cancer, cardiac-stroke, and artery coronary disease. 

There are 3 types of Cardiomyopathy actually, which are : 

1. Dilated Cardiomyopathy.   Is the most common  cardiomyopathy.  In this condition, the left ventricle of the heart is enlarge/dilated, cause the decrement of heart pumping capability.  This abnormality can happen to all gender and ages, but mostly attack mid-age male. In Some cases, it's genetically descending.
2. Hypertrophy Cardiomyopathy.  In this condition, heart muscle does not grow/develop well as it should be. The muscle become thicker and will abnormally effect the ventricle pumping system.  Heart becomes stiff and the the ventricle goes shrinking.  This can also happen to all age and all gender, but more dangerous if experienced by kids than adults.
3. Restrictive Cardiomyopathy. The whole heart muscle becoming stiff and inelastic.  Mostly happen to elders.  This is the fewest  cardiomyopathy type that happen in the world, but usually idiopathic.

Diabetic vs CHF/(I)DCM

So many article and journal so complicated that i can not understand reading them  once or even twice.  Then I decide to make it more simple to digest.    In normal condition, myocardium energy production results from beta-oxidation inside Free Fatty Acid (FFA) 70% and from glucose oxidation 30%.  Nevertheless the usage of glucose in Diabetic Patients as an energy source is extremely low in about 10% only.  So that, FFA is mostly used as an energy source rather than glucose.  It happens because glucose, in diabetic + CHF patients, has a very slow transport speed passing through sarcolemma membrane inside myocardium.  Another cause is hyperglicemia which raise up diacylgycerol level and protein kinase C that could result the depletion of basal membrane, angiogenesis, cardiomyopathy, and disturbance of cardiovascular system.  In other short explanation, the glucose act as a scraper to any membrane, layer, or blood vessel, and make them loosing their elasticity  and sensitivity.   If any one of you have experiences in how sugar or any sweet material can erode pump, mechanical seal, cast iron, or even Stainless Steel very rapidly.  It's the same analogy happen in our blood vessel inside our body. 

How about the relation between diabetic and  kidney failure ? 

with the same basic mechanism that happen in blood vessel, hyperglycemia activates Protein Kinase C (PK C) which stimulate vasoactive hormones that will raise up TGF-beta (Transforming Growth Factor Beta) and VEGF (Vascular Endothelial Growth Factor)  level inside glomerulus and protein matrix.  TGF Beta and VEGF could cause hypertrophy cellular, raise up the colagen synthesis, and changing the vascular characteristic in diabetic patients.  so that results the increment of vascular permeability and accumulation of extracellular matrix and proteinuria which gradually will cause the kidney failure.   The initial morphological change in diabetic nephropathy (kidney failure caused by diabetic condition), is the depletion of Glomerulare Basement Membrane (GBM), and the swelling of mesangium  that caused by the stacking of matrix.   In more simple explanation, the glucose once again erode and deplete the "blood-filter-membrane" in kidney and produce a protein leakage to urinary system, and fail to clean up the blood from waste and impurities.

In summary, I suppose that the excessive glucose level is a quite decisive factor of all problem in our internal organ system, and definitely caused so many silent problems.   So the early precaution of keeping normal blood sugar level become an essential task for people who has the high probability number of getting CHF and kidney problem. Even though not all problem caused by glucose.  In some research, even cancer is fed by glucose and its relatives.  Stop consuming glucose mostly inhibit the growth of the cancer, or even cure it.  Too much of anything will cause you many things.....mate.