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Letter to the Editor
Takotsubo syndrome in the context of severe hypoglycemia
Síndrome de Takotsubo en el contexto de hipoglucemia grave
Víctor José Simón Frapolli
Corresponding author
, José Antonio López Medina, Francisco José Tinahones Madueño
Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; is an acute&#44; regional and transient cardiomyopathy triggered by stressful events&#44; first described by Sato et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in Japan in 1990&#46; Classic TTS is characterized by apical akinesia of the left ventricle with compensatory hyperkinesis of the rest of the myocardial regions&#44; in the absence of coronary artery stenosis or atheromatous plaque rupture&#46; TTS generally occurs more frequently in women than in men &#40;9&#58;1&#41;&#44; especially in postmenopausal women&#44; and is mainly triggered by physical or emotional stress&#44; resulting in exaggerated myocardial exposure to catecholamines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Far from being a benign disease&#44; TTS has high short- and long-term morbidity rates &#40;fatal arrhythmias&#41; and a high mortality rate&#44; of up to 8&#37;&#46; Approximately 95&#37; of patients recover fully&#44; with a recurrence rate of up to 11&#37; if stressors recur<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the clinical case of a 39-year-old male&#44; type 1 diabetic with poor adherence to treatment&#44; who was rushed to hospital due to a low level of consciousness&#44; with severe hypoglycaemia and a capillary measurement of 13&#8239;mg&#47;dl&#46; Physical examination&#58; weight 69&#8239;kg&#44; height 188&#8239;cm &#40;BMI&#58; 19&#46;5&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; blood pressure 112&#47;84&#8239;mmHg&#44; heart rate 112&#8239;lpm&#44; basal oxygen saturation 97&#37; and capillary glycaemia 33&#8239;mg&#47;dl&#44; requiring treatment with intravenous glucose&#46; Complementary tests&#58; glucose 67&#8239;mg&#47;dl&#44; creatinine 0&#46;86&#8239;mg&#47;dl&#44; sodium 141&#8239;mEq&#47;l&#44; potassium 2&#46;8&#8239;mEq&#47;l&#44; lactate 3&#46;8&#8239;U&#47;l&#44; creatinine kinase 179&#8239;U&#47;l&#44; aspartate transaminase 152&#8239;U&#47;l&#44; alanine transaminase 77&#8239;U&#47;l&#44; C-reactive protein &#60;1&#8239;mg&#47;dl&#44; undetectable ethanol and leucocytosis of 23&#46; 760&#47;mL &#40;21&#44;870 neutrophils&#47;mL&#41;&#46; Venous blood gases&#58; metabolic alkalosis with pH 7&#44;473 and HCO 331&#46;8&#8239;mmol&#47;l&#46; Negative toxicity urinalysis Emergency department electrocardiogram&#58; sinus tachycardia with prolonged QTc&#46; Chest X-ray and head CT without pathological findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Subsequently&#44; his hemodynamic status worsened&#44; and a transthoracic echocardiogram and Swan-Ganz catheter placement were performed&#44; observing severe left ventricular dysfunction with morphology compatible with TTS &#40;Fig&#46; A&#46;1&#41;&#44; with reduced ejection fraction and cardiac output &#60;&#8239;2&#8239;l&#47;min despite support with vasoactive drugs&#44; so an intra-aortic balloon was implanted and ventricular support by means of veno-arterial extracorporeal membrane oxygenation was provided&#44; which was removed after 72&#8239;h&#46; Echocardiographic findings returned to normal during follow-up&#46; The electrocardiogram on the second day progressed to a diffuse flattening of T waves&#44; followed by diffuse inversion of T waves that returned to normal on the fourth day&#46; Troponin I values increased since admission with a peak of 1&#44;042&#46;67&#8239;ng&#47;l on the second day&#44; returning to normal on the ninth day&#46; Angiography without significant changes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">CBC&#58; albumin 2&#46;2&#8239;g&#47;dl&#44; prealbumin 19&#46;5&#8239;mg&#47;dl&#46; IgA 559&#8239;mg&#47;dl &#40;normal&#58; 40&#8211;350&#41;&#44; IgM 134&#8239;mg&#47;dl &#40;normal&#58; 50&#8211;300&#41;&#44; IgG 2&#44;109&#8239;mg&#47;dl &#40;normal&#58; 650&#8211;1&#44;600&#41; with subclasses G1 1&#44;430&#8239;mg&#47;dl &#40;normal&#58; 278&#8211;822&#41; and G4 836&#8239;mg&#47;dl &#40;normal&#58; 3&#8211;132&#41;&#46; Anti-glutamate decarboxylase 10&#46;26&#8239;U&#47;mL &#40;normal&#58; &#60;&#8239;5&#41;&#44; anti-tyrosine phosphatase 1&#46;59&#8239;U&#47;mL &#40;normal&#58; &#60;7&#46;5&#41; and anti-insulin antibodies negative&#46; Thyroid hormone and autoimmune profile&#44; celiac profile&#44; complement and normal systemic autoimmunity parameters&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diabetes mellitus &#40;DM&#41; is the most common endocrine disorder in the general population&#44; and hypoglycaemia is its most common complication&#46; However&#44; few cases of TTS associated with hypoglycaemia have been described&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This clinical case is atypical since it is a relatively young male&#44; when TTS usually develops in postmenopausal women<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; In addition&#44; although severe hypoglycaemia is the most important factor in the onset of the condition&#44; protein-calorie malnutrition may also have played a role&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hypoglycaemia is a complication of DM that entails significant adverse effects&#46; It is well known that tight metabolic control in the diabetic patient leading to hypoglycaemia can increase mortality<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Hypoglycaemia is common in the emergency department&#44; but myocardial abnormalities secondary to hypoglycaemia are rarely explored at present&#44; so TTS may go undetected and undiagnosed if its haemodynamic course is benign&#46; Therefore&#44; we should pay more attention to cardiac function in patients with impaired carbohydrate metabolism&#44; considering echocardiography&#44; if necessary&#44; as hypoglycaemia-associated STT may be one of the key factors in the increased cardiovascular morbidity and mortality observed in previous studies focusing on diabetic patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p></span>"
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                    0 => array:2 [
                      "titulo" => "Takotsubo-type cardiomyopathy due to multivessel spasm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Sato"
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                            2 => "T&#46; Uchida"
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                        "titulo" => "Clinical aspect of myocardial injury&#58; from ischemia to heart failure &#40;in Japanese&#41;"
                        "paginaInicial" => "56"
                        "paginaFinal" => "64"
                        "serieFecha" => "1990"
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                      "titulo" => "International expert consensus document on takotsubo syndrome &#40;part I&#41;&#58; clinical characteristics&#44; diagnostic criteria&#44; and pathophysiology"
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                          "etal" => true
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                            0 => "J&#46;R&#46; Ghadri"
                            1 => "I&#46;S&#46; Wittstein"
                            2 => "A&#46; Prasad"
                            3 => "S&#46; Sharkey"
                            4 => "K&#46; Dote"
                            5 => "Y&#46;J&#46; Akashi"
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                      ]
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                        "fecha" => "2018"
                        "volumen" => "39"
                        "paginaInicial" => "2032"
                        "paginaFinal" => "2046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29850871"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "3"
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                      "titulo" => "Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome&#58; a systematic review"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2007.07.002"
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                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2008"
                        "volumen" => "124"
                        "paginaInicial" => "283"
                        "paginaFinal" => "292"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "4"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Amiel"
                            1 => "B&#46;M&#46; Frier"
                            2 => "S&#46;R&#46; Heller"
                            3 => "R&#46;J&#46; McCrimmon"
                            4 => "K&#46; Khunti"
                            5 => "P&#46; Aschner"
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                        ]
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                    ]
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                        "fecha" => "2019"
                        "volumen" => "7"
                        "paginaInicial" => "385"
                        "paginaFinal" => "396"
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Article information
ISSN: 23870206
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos