Mhanna Mohammed, Beran Azizullah, Srour Omar, Ghazaleh Sami, Elzanaty Ahmed
Internal Medicine, The University of Toledo, Toledo, USA.
Cureus. 2020 Oct 7;12(10):e10842. doi: 10.7759/cureus.10842.
Takotsubo cardiomyopathy (TC), also recognized as stress-induced cardiomyopathy, is a transient condition of left ventricular (LV) dysfunction, which presents similarly to acute coronary syndrome (ACS) but with normal coronaries. Physical or emotional stressors usually precipitate TC. It is typically a benign condition, with a complete resolution once the triggering cause resolves. There have been a few cases of TC induced by diabetic ketoacidosis (DKA) that have been reported in the literature. A 50-year-old Caucasian female patient presented with lethargy, in addition to hypothermia and hypotension. Further investigation showed hyperglycemia with metabolic acidosis and ketonemia. Eventually, she was diagnosed with diabetic ketoacidosis (DKA). On Day 2 of the admission, the patient's condition further deteriorated despite appropriate treatment of DKA. An electrocardiogram (EKG) showed ST-segment elevation in inferior leads, and troponin levels were elevated. Cardiac catheterization showed non-obstructive coronary arteries but a severely reduced cardiac index. Echocardiography showed an ejection fraction (EF) of 25% with global hypokinetic LV. Eventually, the patient was diagnosed with TC or stress-induced cardiomyopathy. TC should always be suspected in any patient presenting with acute heart failure during DKA treatment. TC is a transient syndrome; however, it can result in dreadful complications, including cardiogenic shock, arrhythmias, or thromboembolic events. Early recognition and timely treatment are pivotal in such cases.
应激性心肌病（TC），也被认为是应激性心肌病，是一种左心室（LV）功能障碍的短暂病症，其表现与急性冠状动脉综合征（ACS）相似，但冠状动脉正常。身体或情绪应激源通常会引发TC。它通常是一种良性病症，一旦触发原因消除，即可完全恢复。文献中已有少数由糖尿病酮症酸中毒（DKA）诱发TC的病例报道。一名50岁的白种女性患者除了体温过低和低血压外，还出现嗜睡症状。进一步检查显示血糖升高伴代谢性酸中毒和酮血症。最终，她被诊断为糖尿病酮症酸中毒（DKA）。入院第2天，尽管对DKA进行了适当治疗，但患者病情进一步恶化。心电图（EKG）显示下壁导联ST段抬高，肌钙蛋白水平升高。心脏导管检查显示冠状动脉无阻塞，但心脏指数严重降低。超声心动图显示射血分数（EF）为25%，左心室整体运动减弱。最终，患者被诊断为TC或应激性心肌病。在DKA治疗期间，任何出现急性心力衰竭的患者都应始终怀疑患有TC。TC是一种短暂的综合征；然而，它可能导致可怕的并发症，包括心源性休克、心律失常或血栓栓塞事件。在这种情况下，早期识别和及时治疗至关重要。
