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pubmed-article:9017359pubmed:abstractTextSudden death at night is known to occur in young patients with insulin-dependent (Type 1) diabetes mellitus (IDDM) but the aetiology is uncertain. A cardiac arrhythmia has been postulated, but there has been little evidence to support this. We present the case of a 31-year-old man with IDDM of 17 years duration, who died suddenly while asleep. Over preceding months, he had had strict glycaemic control (HbA1 8.9%), normal 24 h blood pressure (mean 131 +/- 2.1/76 +/- 2.2 mmHg), no evidence of microangiopathy or endothelial dysfunction and normal standard clinical tests of autonomic function. An electrocardiogram was similarly unremarkable, with a QTc interval of 0.414 s, and an echocardiogram had demonstrated normal left ventricular mass index (96.4 g m-2). However, there was no nocturnal dip in heart rate (daytime 74 +/- 2.7, and nocturnal 68 +/- 1.6 beats min-1), and he had grossly impaired baroreflex sensitivity during Phase 4 of the valsalva manoeuvre (0.5 ms mmHg-1), with power spectral analysis studies suggesting an abnormality of parasympathetic function. The coroner's autopsy demonstrated no structural abnormalities. We hypothesize that abnormal baroreflex sensitivity could either predict a risk of or account for some of the unexplained deaths in IDDM, in that relative overactivity of the sympathetic nervous system could cause ventricular arrhythmias.lld:pubmed
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pubmed-article:9017359pubmed:authorpubmed-author:WestonP JPJlld:pubmed
pubmed-article:9017359pubmed:authorpubmed-author:BennettM AMAlld:pubmed
pubmed-article:9017359pubmed:authorpubmed-author:McNallyP GPGlld:pubmed
pubmed-article:9017359pubmed:authorpubmed-author:LawrenceI GIGlld:pubmed
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pubmed-article:9017359pubmed:volume14lld:pubmed
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pubmed-article:9017359pubmed:pagination82-5lld:pubmed
pubmed-article:9017359pubmed:dateRevised2006-11-15lld:pubmed
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pubmed-article:9017359pubmed:year1997lld:pubmed
pubmed-article:9017359pubmed:articleTitleIs impaired baroreflex sensitivity a predictor or cause of sudden death in insulin-dependent diabetes mellitus?lld:pubmed
pubmed-article:9017359pubmed:affiliationDepartment of Medicine and Therapeutics, University of Leicester, Leicester Royal Infirmary, UK.lld:pubmed
pubmed-article:9017359pubmed:publicationTypeJournal Articlelld:pubmed
pubmed-article:9017359pubmed:publicationTypeCase Reportslld:pubmed
pubmed-article:9017359pubmed:publicationTypeResearch Support, Non-U.S. Gov'tlld:pubmed
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