Title: Hypoglycemia: An Acute Coronary Syndrome Mimic
Authors: Vishal Singh, Satish Chandra Mishra, Binod B Raut
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.29
Abstract
Background: Type-2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular events. A good glycemic control, while reducing the risk of cardiovascular events, increases the risk of hypoglycemia. These hypoglycaemic events, at times, may precipitate reversible electrocardiographic (ECG) changes, causing a diagnostic dilemma.
Case Description: A 55 years old lady with long-standing T2DM and diabetic kidney disease presented with anginal chest pain, ST-segment depression involving the anterior chest leads, elevated cardiac biomarkers, and neuroglycopenic hypoglycemic episode. The coronary angiogram was normal. The ECG normalized spontaneously following the correction of blood sugars.
Conclusions: Severe acute hypoglycemic episode, may at times, present with reversible ECG changes mimicking myocardial ischemia. In such circumstances, it is prudent to repeat the ECG after blood sugar correction, before instituting invasive interventions.
Keywords: Acute hypoglycaemia; Acute Coronary Syndrome; Electrocardiographic Changes.
References
- Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001;44 Suppl 2:S14-21.
- ACCORD study group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545-59.
- Duckworth W, Abraira C, Moritz T, Redad D, Emmanuele M, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360:129-39.
- Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev 2008;24: 353–363.
- Meinhold, T. Heise, K. Rave, and L. Heinemann, “Electrocardiographic changes during insulin-induced hypoglycemia in healthy subjects,” Hormone and Metabolic Research, vol. 30, no. 11, pp. 694–697, 1998.
- L. Koivikko, M. Karsikas, P. I. Salmela et al., “Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes,” Diabetologia, vol. 51, no. 3, pp. 426–435, 2008.
- Koivikko ML, Karsikas M, Salmela PI, et al. Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes. Diabetologia 2008; 51: 426–435.
- Gupta AK. ECG in Hypoglycemia: Mimic Isoelectric ECG. JAPI 2011;59: 269-70.
- Graveling AJ, Frier BM. Does hypoglycaemia cause cardiovascular events? Br J Diabetes Vasc Dis 2010; 10:5–13.
- Kamijo Y, Soma K, Aoyama N, Fukuda N, Ohwada T. Myocardial infarction with acute insulin poisoning: A case report. Angiology 2000; 51:689-93.