Takotsubo cardiomyopathy triggered by hypoglycemic coma after anorexia: a case report

Takotsubo cardiomyopathy triggered by hypoglycemic A 61-year-old woman with a history of diabetes mellitus arrived at our hospital’s emergency department in hypoglycemic coma following loss of appetite for 3 weeks. Initial blood glucose level was 24 mg/dL. Although she respond-ed to intravenous glucose administration and recovered from the coma, electrocardiography demonstrated ST elevation in leads II, III and aVF, and echocardiography revealed asynergy at the cardiac apex. This episode was followed by slightly increased serum levels of creatine kinase MB and troponin I. ST elevation had almost returned to baseline at 1 hour after admission, but 2 hours later, negative T waves were observed in leads II, aVF and V6. Coronary angi-ography revealed no critical coronary artery disease, and left ventriculography showed apical and inferior wall hypo-kinesis. Takotsubo cardiomyopathy was diagnosed. Her clinical course was uneventful. Although the electrocardiogram (ECG) showed deep T-wave inversion in leads II, III and aVF, echocardiographic evaluation on hospital day 7 showed resolution of the left ventricular dysfunction. Only a few cases of takotsubo cardiomyopathy after hypoglycemic coma have been reported. When prolonged anorexia causes hypoglycemia in a patient and an abnormal ECG is observed, the possibility of takotsubo cardiomyopathy should not be overlooked.