One of the most common chronic illnesses in the United States is diabetes and heart disease and in Los Angeles it’s common for the two to occur together. Many Californians have diabetes and are told they might need surgery on their heart. Before going to the operating room, they need to understand how diabetes and heart disease are related.

People with diabetes are more likely to develop heart disease and the two conditions are related. Diabetes affects how the body works both at the cellular level and at the level of the blood vessels. These changes are serious and have a direct impact on the health of the heart and on how easy or difficult it is to recover after surgery. The good news is that with proper planning, a good surgical team, and understanding their condition, people with diabetes can have heart surgery and then go on to make a full recovery and live a more active life.

Maria Tehrani, a cardiac surgeon, helps patients affected by heart disease and diabetes in the greater Los Angeles area. She works at the Ronald Reagan UCLA Medical Center in Westwood and provides patients with personalized plans to manage heart disease and diabetes by providing in-depth surgical prep and a thorough review of the patient’s history.

Why the Link Between Diabetes and Heart Disease is Important to Surgery

When contemplating the links between diabetes and heart disease, the first thing to consider is how diabetes affects the blood vessels, as this is often the most critical concern.

Why Blood Vessels Are Affected by Diabetes

Most cases of diabetes are Type 2, which is characterized by consistently high blood sugar levels. This condition damages the blood vessel walls all around the body, including those in the heart.

This condition, called diabetic vascular disease, is accompanied by atherosclerosis, which is the formation of fatty plaques in the arteries. This narrows and hardens the arteries. When this condition manifests itself in the blood vessels of the heart, it leads to coronary artery disease (CAD). This condition is one of the most common causes of a heart surgery.

An individual with diabetes is 2 to 4 times more likely to develop coronary artery disease compared to a person without diabetes. This is an alarming statistic that highlights the importance of maintaining an active relationship with your cardiology team.

Diabetes And Its Effects On The Heart Muscle

Diabetes can have a negative impact on the heart muscle in a condition referred to as diabetic cardiomyopathy. This is when high blood glucose levels, without the presence of coronary artery disease, cause the heart muscle to undergo certain structural and functional modifications that reduce the efficacy of the heart to pump blood and, in turn, increases the probability of heart failure.

Diabetic cardiomyopathy can occur in people who have blood sugar levels that are excellently managed, as well as in people who do not exhibit any other manifestations of cardiovascular disease. This fact, among others, is what makes repeated and routine cardiac evaluations imperative for the diabetic population in the greater Los Angeles region.

Overview for Divided Autonomic Nervous System

Another consequence of diabetes is the damage it can do to the autonomic nervous system. Specifically, diabetes can damage the part of the autonomic nervous system that controls involuntary actions like the heart rate and blood pressure. This damage can lead to a condition known as cardiac autonomic neuropathy which can lead to irregular heartbeats as well as make it difficult to feel chest pain (this is referred to as silent ischemia) and make it so that the autonomic nervous system is unable to respond to stress and exercise.

Silent ischemia is a particular danger to people with diabetes because it could mean that serious cardiac events (even heart attacks) could be occurring while the person does not feel symptoms that would cause them to seek medical help. This is a reason why there are no symptoms that diabetic patients are often advised to get cardiac screenings. This is often the case for diabetic patients in Los Angeles as the screenings are vital to their health.

Elevated Surgical Risk Due to Diabetes

There are additional risks and considerations that the surgical team must factor in when a heart surgery patient is diabetic. Knowing these risks should not dissuade diabetic patients from undertaking necessary surgery. Rather, it is vital that patients are aware of the risks so that they can be better prepared for their operation.

Increased Risk of Infection

One of the big surgical concerns for diabetes patients is the risk of developing an infection. High blood sugar is the result of the body taking a long time to produce and/or respond to the insulin, which makes blood sugar levels dangerously high. Because of the blood sugar levels, the body’s white blood cells cannot function. White blood cells are the body’s defenders against bacteria and fight to heal the body. Because of the increased blood sugar levels, the body’s ability to fight off bacteria becomes impaired.

When diabetes patients undergo cardiac surgeries in Los Angeles, they become susceptible to a greater likelihood of developing infection of the wounds created during the surgeries, some of which may be difficult to treat. Thus, the management of blood sugar levels before and after the surgeries plays a role in minimizing the likelihood of developing infections of the surgical wound.

Slower Wound Healing

Patients suffering from diabetes experience a condition where their body loses the ability to heal wounds in a timely manner. This is known as poor blood circulation, and it is a complication that results from having diabetes for a long time. This condition results in the surgical site receiving a far less amount of oxygenated blood, which is needed to be delivered to the site for the purpose of repairing the tissues. This challenge is even greater for patients suffering from diabetes and peripheral vascular disease, as the device sustaining blood flow from the heart is required to be repaired or replaced.

Issues with Kidney Function

Many diabetic patients have some form of kidney disease, including diabetic nephropathy, which becomes important when considering cardiac surgery because the kidneys are important in processing contrast dyes in imaging studies, the kidneys filter and remove anesthetic drugs, and the kidneys manage the fluid shifts from and to the body during the surgery.

Patients with even mildly impaired kidney function reactive alterations major cardiac surgery because of the renal protection and risk of acute kidney injury, which is a major post-operative complication.

Surgical Stress & Blood Sugar Control

Stress during major cardiac surgery is a big enough physiological insult to the body to create a stress response with the release of cortisol and adrenaline, and one of the direct effects of those stress hormones is a rise in blood sugar, making it even harder to control in diabetic patients during and post op.

At UCLA Medical Center they have their cardiothoracic surgical patients under tight glycemic control in the pre and post op periods and it is thought to be one of the factors associated with better outcomes in those patients.

Increased Possibility of Cardiovascular Issues

Before and after surgery, diabetic patients that require cardiac surgery are at an increased risk for negative cardiovascular outcomes like stroke, irregular heart rhythms, and extended mechanical heart support. These risks are evaluated by the surgical team for the surgery and their postoperative care plan.

What Should Los Angeles Diabetic Patients Do Before Cardiac Surgery?

Diabetes does complicate matters in almost all aspects of cardiac surgery, but there is plenty that patients can (and should) do in the weeks and months prior to the surgery to reduce those complications and improve outcomes. For Dr. Tehrani, Los Angeles diabetic patients awaiting cardiac surgery can take the following actions.

1. Optimize Blood Sugar Control

Before cardiac surgery, the most important thing that a diabetic patient can do is try to achieve the best possible control of their blood sugars. This often requires coordinated efforts from both your endocrinologist as well as your cardiac surgeon to modify some of your medications, dietary changes, and a big commitment to frequent glucose monitoring. Typically, before heart surgery, an HbA1c target of less than 7.5 to 8 percent is optimal. HbA1c is a metric for blood sugar levels of the last 2-3 months. However, depending on your scenario, your care team may establish targets that differ from the general guideline.

2. Additional Cardiac Testing

In Los Angeles, Diabetic patients having heart surgery need additional cardiac evaluations, which surpass normal evaluations. These can range from cardiac stress tests, advanced imaging of the heart, and an extensive evaluation of the coronary arteries, and the severity and location of the disease. All of this aids Dr. Tehrani and her team in assisting us with organizing the safest and most effective surgery for each patient individually.

3. Protection of Kidney Function

Before surgery, if you have any stage of kidney disease, it is required that you have your renal function assessed, and the renal function be optimized. This could require medication adjustments, for renal function, and could require collaboration with a nephrologist. This is part of your pre-surgical team at UCLA Medical Center in Westwood.

4. Blood Pressure, and Cholesterol Control

Diabetic patients have a high occurrence of Hypertension, and high Cholesterol. This greatly increases the risk for cardiac surgery. Even more, the risk is heightened if patients have poorly controlled Hypertension, and high Cholesterol prior to surgery. Therefore, it is imperative that patients have their blood pressure, and cholesterol, controlled with the aid of medication, diet, and lifestyle modification.

5. Stop Smoking

For diabetic patients in Los Angeles who smoke, one of the most important steps you can take before cardiac surgery is to quit. The negative effects of smoking are multiplied when combined with diabetes and heart surgery. Smoking makes the circulation and infection problems worse, diabetes impairs wound healing, and increases the chances of pulmonary complications after surgery. The cardiac surgery team at UCLA is able to help you stop smoking before your surgery.

6. Improve Your Diet

The body can heal itself better and faster when it is well nourished. Your recovery time can improve if you speak to a registered dietitian before your surgery and increase the amount of protein, vitamins, and minerals you are having. In addition, make sure your blood sugar is controlled. UCLA Medical Center and the surrounding health care system have great support for patients in Los Angeles to help meet these nutritional needs.

7. Stay as Physically Active as Your Condition Allows

Depending on your cardiac condition, and guided by your physician, physical activity, even at lower levels, helps preserve muscle, and heart function, and provides better overall fitness to undergo surgery. Even simple walking can help many diabetic cardiac patients in the pre-surgical period.

Cardiac Surgery Recovery Expectations for Diabetics

For diabetic patients after cardiac surgery, recovery is likely to be longer, more complex, and require more diligence than for those without diabetes. The following outline applies to post-operative patients with diabetes living in Los Angeles.

Increased Blood Sugar Control

During the post-operative period, patients typically undergo continuous monitoring of blood sugars. To manage sugars, insulin will be continuously infused. After surgery, burned tissue becomes a focus for infection. To reduce the risk of infection, and promote healing, careful control of blood sugars is a vital element of the early post-operative period.

Increased Length of Stay

In the days following cardiac surgery, diabetic patients may experience a longer hospital stay than their non-diabetic counterparts, due to the need for more complex management of blood sugars, assessment for adequate healing of surgical sites and kidney function, and monitoring for infection and other complications.

Cardiac Rehabilitation

All patients who undergo cardiac surgery are recommended cardiac rehabilitation. This includes patients who have diabetes, as rehabilitation can have even greater benefits. In the Los Angeles area, there are numerous rehabilitation programs. For patients who are diabetic, the benefits of these programs are even greater after cardiac surgery.

Ongoing Coordination Between Specialists

In Los Angeles, patients with diabetes who have had cardiac surgery will require further coordination among their caregivers. This includes the cardiac surgeon, cardiologist, endocrinologist, and primary care physician, due to the interplay of their heart and diabetes. This type of multidisciplinary care is available as part of the comprehensive cardiac program at the Ronald Reagan UCLA Medical Center in Westwood.

A Message to Los Angeles Patients Living With Diabetes

For patients living with diabetes, and facing heart surgery, it is understandable to feel overwhelmed. The merging of these conditions adds to the complexity, but it does not mean that the surgery will not be successful, nor that the patient will not be able to fully recover.

How does your situation describe the need for a cardiologist in Los Angeles? What your situation describes is needing a Los Angeles cardiac surgeon who understands the specific complications diabetic patients have. This surgeon must be willing to prepare you and watch over the multiple steps in the process of providing the specific care and detail your situation demands.

Dr. Maria Tehrani is the cardiac surgeon diabetic patients are deserving of, and she is the one who specializes in that type of practice at the Ronald Reagan UCLA Medical Center, Westwood. So, if you are a diabetic patient in Los Angeles and have been advised that you perhaps need cardiac surgery, or you merely want to clarify what your options and possible complications are, then you may contact Dr. Tehrani.

Contact Dr. Maria Tehrani, Westwood, Los Angeles

📞 818-350-9899

📧 welcome@mariatehranimd.com