Itagaki Hideya, Abe Yoshinobu, Endo Tomoyuki
Department of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, JPN.
Cureus. 2022 Dec 14;14(12):e32527. doi: 10.7759/cureus.32527. eCollection 2022 Dec.
Takotsubo syndrome (TTS) is a disorder with transient cardiac dysfunction triggered by stress. Rarely, hypoglycemia can also trigger TTS, but there are no case reports of repeated TTS due to hypoglycemia. We report the case of a 51-year-old Japanese woman who was brought to the emergency department with impaired consciousness and shock vitals. Blood tests revealed severe hypoglycemia. She also had an abnormal electrocardiogram with a QS pattern in the anterior thoracic guidance, which led to the diagnosis of TTS after repeated echocardiographic evaluation by a cardiologist. The diagnosis of hypoglycemic coma was made, and the patient was admitted to the intensive care unit (ICU). The patient had anorexia nervosa and had been suffering from a hypoglycemic coma due to anorexia for some time. The patient had a history of hypoglycemic coma about one year before and had been hospitalized in the ICU with TTS at that time. We report the world's first case of repeated TTS due to hypoglycemia. Since hypoglycemia is hemodynamically associated with increased heart rate and systolic blood pressure, TTS should be included in the differential diagnosis when shock vitals are repeated in patients with frequent hypoglycemia.
应激性心肌病（TTS）是一种由应激引发的短暂性心脏功能障碍疾病。低血糖也可引发TTS，但极为罕见，且尚无因低血糖导致反复发生TTS的病例报告。我们报告一例51岁日本女性病例，该患者因意识障碍和生命体征休克被送至急诊科。血液检查显示严重低血糖。她还伴有异常心电图，胸前导联呈QS波型，经心脏病专家反复超声心动图评估后诊断为TTS。诊断为低血糖昏迷，患者被收入重症监护病房（ICU）。该患者患有神经性厌食症，因厌食导致低血糖昏迷已有一段时间。患者约一年前有过低血糖昏迷病史，当时因TTS入住ICU。我们报告了世界上首例因低血糖导致反复发生TTS的病例。由于低血糖在血流动力学上与心率加快和收缩压升高相关，对于频繁发生低血糖且出现反复生命体征休克的患者，鉴别诊断时应考虑TTS。
