In patients with diabetes mellitus, if the combined coronary artery disease is a combination of diabetes mellitus with changes in the large arteries, this is not a precursor to death. In contrast, if diabetes mellitus combined with coronary artery disease leads to acute myocardial infarction or acute heart failure, certain precursors of death will occur, such as patients will have significant chest tightness, shortness of breath, palpitations, arrhythmia, tachycardia, accelerated heart pain, or will have significant anterior precordial crushing or strangulation pain, which usually does not improve significantly with sublingual nitroglycerin. In addition, patients may experience cardiogenic shock, confusion, loss of consciousness, unmeasured blood pressure, pallor, clammy cold, undetectable pulse, no pulsation in the carotid artery, weak respiration, and cardiac arrest, all of which are precursors to death due to diabetes combined with coronary heart disease.