Q: Why do patients suffering from diabetes have no pain when they experience an heart attack? Two years ago, my diabetic uncle, expired due to a sudden massive cardiac arrest. According to the family members, he vomited in the early hours of morning and everyone thought that it was due to some indigestion. But after an hour or so, he felt an urge to defecate and collapsed in the bathroom itself. Why do vomiting and defecation precede an heart attack? Why does this usually occur in the early hours of the morning? Why is the attack all of a sudden so massive? Could this be an indication that the heart was failing much before it could be recognised? Are all vomiting liable to be suspected as a warning to a cardiac arrest? If so, then what could be done to save the person?

A:Long standing diabetics have what in medical terminology known as neuropathy i.e. the nerve endings are also involved in the diabetic process. So they are insensitive to pain. Generally they do not have angina per se. The cardiac symptoms present as breathlessness and early fatigue. These symptoms in a diabetic patient have to be taken seriously and they should get a thorough cardiac evaluation. Generally heart attacks are preceded by sweating and vomiting and urge of defecation. So they should be given two tablets of chewable aspirin which halts the heart attack. Meanwhile, they should be taken to a nearest hospital with intensive cardiac care facilities. Generally the symptoms of heart attack mimic those of indigestion. When ever such symptoms occur they should not be taken lightly.