Escaño Lorena, Desai Prarthana, Chaudhry Samir
Internal Medicine, Danbury Hospital, Danbury, USA.
Cureus. 2024 Jul 19;16(7):e64907. doi: 10.7759/cureus.64907. eCollection 2024 Jul.
Diabetic ketoacidosis (DKA) is one of the hyperglycemic emergencies seen in patients with poorly controlled diabetes mellitus. One of the potential cardiovascular complications of this hyperglycemic crisis, not that well documented in the literature, is takotsubo cardiomyopathy (TCM) also known as stress-induced cardiomyopathy or "broken heart syndrome". It is a reversible condition where the heart muscle becomes suddenly weakened and stunned, which is mostly known to develop in patients who have suffered a stressful life event or are undergoing an acute illness. We present an interesting case of a 45-year-old female with a history of poorly controlled diabetes mellitus who presented with significant hyperglycemia and laboratory results concerning DKA. The patient was also complaining of new-onset chest pain on arrival. Further workup revealed elevated troponin, severely reduced ejection fraction, and echocardiographic findings concerning TCM. The coexistence of DKA and TCM is rare but clinically significant. This case emphasizes the value of clinical vigilance in patients with this hyperglycemic crisis and encourages us to always consider stress-induced cardiomyopathy as a potential complication. Further research is needed to better elucidate the exact mechanisms linking DKA and stress-induced cardiomyopathy. This will help improve outcomes and prevent recurrence in this vulnerable patient population.
糖尿病酮症酸中毒（DKA）是糖尿病控制不佳患者中出现的高血糖急症之一。这种高血糖危机的潜在心血管并发症之一是应激性心肌病（TCM），也称为应激性心肌病或“心碎综合征”，在文献中对此记载并不充分。这是一种可逆性病症，其中心肌会突然变弱并受到损伤，多见于经历过应激性生活事件或正在患急性病的患者。我们报告一例有趣的病例，一名45岁女性，有糖尿病控制不佳病史，出现显著高血糖及与DKA相关的实验室检查结果。患者入院时还主诉新发胸痛。进一步检查发现肌钙蛋白升高、射血分数严重降低以及与应激性心肌病相关的超声心动图表现。DKA和应激性心肌病同时存在较为罕见，但具有临床意义。该病例强调了对此高血糖危机患者进行临床警惕的重要性，并促使我们始终将应激性心肌病视为一种潜在并发症。需要进一步研究以更好地阐明DKA与应激性心肌病之间的确切关联机制。这将有助于改善此类脆弱患者群体的治疗效果并预防复发。
