Takotsubo Cardiomyopathy in the Setting of Severe Hyperglycemia

1Mercy Catholic Medical Center, Darby, PA
2Mercy Catholic Medical Center, Darby, PA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 395

Case Presentation:

A 78‐year‐old African American woman with a medical history of hypertension, hypercholesterolemia, and type 2 diabetes was brought to ED with change in mental status. Patient was living by herself and the family found the patient to be confused. Patient had not been taking her medications for the past 3 days. Physical examination revealed dry oral mucosa. Initial blood glucose was 508 mg/dL, beta hydroxybutyrate 1.4 mmol/L, lactate 2.6 mmol/L and HbA1C 11.2%. Chest x‐ray was unremarkable. CT head was negative. EKG showed sinus rhythm, nonspecific ST changes. Patient was treated with subcutaneous insulin and intravenous hydration. The capillary glucose remained elevated at 499, 517, and 467 mg/dL, and on the night of admission, she had an episode of chest discomfort. Repeat EKG showed new anterior precordial T‐wave inversions. Cardiac enzymes were elevated with troponin T of 0.37 ng/mL (<0.05) and patient was treated as non‐ST‐elevation myocardial infarction with intravenous heparin and integrillin. Cardiac catheterization showed 40% stenosis of mid circumflex artery. Left ventriculography showed dyskinesia of mid anterior wall, with anteroapical, apical and inferoapical segments contracting briskly. This was compatible with Takotsubo cardiomyopathy.

Discussion:

This is a case of Takotsubo cardiomyopathy in the setting of severe hyperglycemia. Takotsubo cardiomyopathy, also known as stress induced cardiomyopathy is a rare condition characterized by transient left ventricular systolic dysfunction mimicking acute myocardial infarction. It is typically seen in states of catecholamine excess. Oe et all reported a case of Takotsubo cardiomyopathy with hyperglycemic hyperosmolar state (HHS). They proposed that hyperosmolarity‐induced increase in myocardial intracellular calcium might be the underlying mechanism of Takotsubo cardiomyopathy in HHS.

Conclusions:

The purpose of reporting of this case is to raise awareness of this potential life threatening condition associated with severe hyperglycemia and highlight the importance of glycemic control in inpatient hospital stay.

To cite this abstract:

Somasundaram A, Al‐Bataineh M. Takotsubo Cardiomyopathy in the Setting of Severe Hyperglycemia. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 395. https://www.shmabstracts.com/abstract/takotsubo-cardiomyopathy-in-the-setting-of-severe-hyperglycemia/. Accessed December 10, 2018.

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