Katayama Yoichi, Hifumi Toru, Inoue Junichi, Koido Yuichi
Department of Emergency Medicine, Sapporo Medical University Hospital, Sapporo City, Hokkaido, Japan.
BMJ Case Rep. 2013 Apr 3;2013:bcr2012008143. doi: 10.1136/bcr-2012-008143.
Takotsubo cardiomyopathy is known to be triggered by some stress. We report the first case of Takotsubo cardiomyopathy induced by hypothermia and diabetic ketoacidosis (DKA). A 59-year-old woman was brought to our emergency department. Upon examination, she was found to be lethargic and disoriented. The body temperature was 30.9°C, blood pressure was 86/68 mm Hg, blood glucose level was 1018 mg/dl. Urinalysis revealed the presence of ketones and arterial blood gas analysis revealed pH 6.87. She was diagnosed with DKA and accidental hypothermia. An ECG demonstrated a J wave (V(4-5)) and ST-segment elevation (V(3-5)), and an ultrasound cardiogram revealed contractile failure of the left ventricular wall at the apex with hypercontraction of the basal segment. Coronary artery disease was ruled out by coronary angiography, and the diagnosis of Takotsubo cardiomyopathy was confirmed. Physicians should keep in mind that Takotsubo cardiomyopathy can be induced by accidental hypothermia and DKA.
已知应激可引发应激性心肌病。我们报告首例由低温和糖尿病酮症酸中毒（DKA）诱发的应激性心肌病病例。一名59岁女性被送至我院急诊科。经检查，发现她精神萎靡且意识模糊。体温为30.9°C，血压为86/68 mmHg，血糖水平为1018 mg/dl。尿液分析显示存在酮体，动脉血气分析显示pH值为6.87。她被诊断为DKA和意外低温。心电图显示有J波（V（4 - 5））和ST段抬高（V（3 - 5）），超声心动图显示心尖部左心室壁收缩功能衰竭，基底节段过度收缩。冠状动脉造影排除了冠状动脉疾病，确诊为应激性心肌病。医生应牢记，意外低温和DKA可诱发应激性心肌病。
