Stress-induced cardiomyopathy after diabetic ketoacidosis – A case report

Liu, Rong; Zhang, Jing; Gao, Xinyuan

doi:10.1016/j.medcli.2018.11.003

array:24 ["pii" => "S0025775318307206" "issn" => "00257753" "doi" => "10.1016/j.medcli.2018.11.003" "estado" => "S300" "fechaPublicacion" => "2019-10-11" "aid" => "4693" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2019;153:300-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S238702061930395X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.11.035" "estado" => "S300" "fechaPublicacion" => "2019-10-11" "aid" => "4693" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2019;153:300-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Stress-induced cardiomyopathy after diabetic ketoacidosis – A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "301" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miocardiopatía inducida por estrés despues de cetoacidosis diabética. Estudio de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rong Liu, Jing Zhang, Xinyuan Gao" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rong" "apellidos" => "Liu" ] 1 => array:2 [ "nombre" => "Jing" "apellidos" => "Zhang" ] 2 => array:2 [ "nombre" => "Xinyuan" "apellidos" => "Gao" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775318307206" "doi" => "10.1016/j.medcli.2018.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318307206?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061930395X?idApp=UINPBA00004N" "url" => "/23870206/0000015300000007/v2_201910291451/S238702061930395X/v2_201910291451/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0025775319300041" "issn" => "00257753" "doi" => "10.1016/j.medcli.2018.12.007" "estado" => "S300" "fechaPublicacion" => "2019-10-11" "aid" => "4737" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2019;153:301-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "A rare case of spontaneous ureteral rupture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso raro de rotura espontánea del uréter" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 896 "Ancho" => 850 "Tamanyo" => 128847 ] ] "descripcion" => array:1 [ "en" => "3D reconstruction of the contrast-enhanced computed tomography in the excretory phase allows a global perspective on the rupture of the left upper collecting system (black arrow) with extravasation of contrast-opacified urine into the retroperitoneal space (red arrow)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carolina Sequeira, Marta Custódio, Anabela Salgueiro Marques" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carolina" "apellidos" => "Sequeira" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Custódio" ] 2 => array:2 [ "nombre" => "Anabela" "apellidos" => "Salgueiro Marques" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020619303961" "doi" => "10.1016/j.medcle.2018.12.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619303961?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319300041?idApp=UINPBA00004N" "url" => "/00257753/0000015300000007/v1_201910040650/S0025775319300041/v1_201910040650/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0025775318305347" "issn" => "00257753" "doi" => "10.1016/j.medcli.2018.07.018" "estado" => "S300" "fechaPublicacion" => "2019-10-11" "aid" => "4630" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;153:298-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 12 "formatos" => array:2 [ "HTML" => 7 "PDF" => 5 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta científica" "titulo" => "Fidaxomicina en el tratamiento de la infección por Clostridium difficile en el paciente oncohematológico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "298" "paginaFinal" => "299" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Fidaxomicin in the treatment of Clostridium difficile infection in oncohematology patients" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lara Martín Rizo, María Malpartida Flores, Luis Carlos Fernández Lisón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lara" "apellidos" => "Martín Rizo" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Malpartida Flores" ] 2 => array:2 [ "nombre" => "Luis Carlos" "apellidos" => "Fernández Lisón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020619303663" "doi" => "10.1016/j.medcle.2018.07.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619303663?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318305347?idApp=UINPBA00004N" "url" => "/00257753/0000015300000007/v1_201910040650/S0025775318305347/v1_201910040650/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Stress-induced cardiomyopathy after diabetic ketoacidosis – A case report" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "301" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rong Liu, Jing Zhang, Xinyuan Gao" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rong" "apellidos" => "Liu" ] 1 => array:2 [ "nombre" => "Jing" "apellidos" => "Zhang" ] 2 => array:4 [ "nombre" => "Xinyuan" "apellidos" => "Gao" "email" => array:1 [ 0 => "15369337970@163.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "The First Clinical Hospital of Harbin Medical University, China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miocardiopatía inducida por estrés despues de cetoacidosis diabética. Estudio de un caso" ] ] "textoCompleto" => "Stress-induced cardiomyopathy (SIC) is a form of reversible, nonischemic cardiomyopathy reported to be triggered by stressful events, which was first described by Dote et al. in 1991.<a class="elsevierStyleCrossRef" href="#bib0025">1</a> We searched previous cases and found that there is less case report of SIC after diabetic ketoacidosis (DKA), except a case which reported a patient with both hyperthyroidism and DKA. In this article, we report a patient who was suspected to be a SIC after DKA. The serum troponin (TNI) value of the patient is very high. And we believe that this case is the first, rare, and with characteristic which is not included in the general standards.A 61-year-old male with 10-year history of type 2 diabetes and high blood glucose level presented to our hospital with nausea and vomiting that he had been experiencing for three days. The patient was treated and diagnosed as diabetic ketoacidosis (DKA) with blood glucose of 40mmol/l in other hospitals one day ago, and there was no obvious effect after adequate fluid replacement and blood glucose lowering. The patient used premixed insulin for diabetic treating before, and there was no obvious inducing factor in this symptom. The patient suddenly appeared chest tightness and chest pain after 4h. An 18-lead ECG obtained ST segment depression of multiple lead and lowering of T-wave. He was found to have high level CKMB of 38.74ng/ml (normal<5.2), and TNI of 18,840.65pg/ml (normal<34.2). Urine examination displayed keto-bodies (ket) of positive 1 level (1+), glu of 1+. After that he was transferred to the medical treatment of cardiovascular medicine. Echocardiography showed motion incoordination of ventricular wall and diastolic dysfunction in the LV with ejection fraction (EF) of 60%. The current treatment planning is anticoagulation, nourish myocardium, and lowing blood glucose. At the second day, the blood examination displayed CO2 combining power (CO2CP) of 16.7mmol/l (22<normal<29), NT-ProBNP of 3371pg/ml (normal<300), TNI of 5874.21pg/ml (normal<34.2) and CKMB of 36.9U/L (normal<25). Arterial blood gas analysis showed the value of pH was 7.257. Urine examination displayed ket of 4+, glu of 3+. This suggested that the DKA still existed. The ECG was basically normal at that time. After two days treatment of dilatation of blood vessels, anticoagulation and lowing blood glucose, the symptoms of chest pain and chest tightness disappeared completely. The patient refused coronary angiography or percutaneous coronary intervention if necessary, demanded to leave the hospital. The ECG is normal when he leaves the hospital. A retrospective visit was made to that patient two weeks later. He indicated that the above symptoms were no longer occurring and the blood glucose control was well. And he checked the echocardiography again, the result is normal.In the International Takotsubo Registry of 1750 patients, 36% had a physical trigger, 27.7% had emotional stressors, and 28.5% had no triggers at all.<a class="elsevierStyleCrossRef" href="#bib0030">2</a> The patient in this article was confirmed to be SIC after DKA highly likely. As far as we know, it is rare that DKA induced SIC. It was hardly seen in the literatures, except a case which reported a patient with both hyperthyroidism and DKA. Myrto Eliades et al.<a class="elsevierStyleCrossRef" href="#bib0035">3</a> reported a case of thyroid crisis in a 71-year woman who had DKA two days ago. The left ventricular function improved after dexamethasone and anti-thyroid drug treatment. The case did not show the related content of DKA of this patient. It seems that this case of SIC may also be caused by DKA.SIC is widely concerned because it is difficult to identify with AMI. There is no specific diagnostic standard for SIC, the most commonly used is Mayo diagnostic criteria.<a class="elsevierStyleCrossRef" href="#bib0040">4</a> This case is different from AMI in two aspects. On the one hand, the symptoms and TNI were rapidly regressed and echocardiography is also normal. On the other hand, the TNI level is very high, which is different from other cases reported previously and Mayo diagnostic criteria. If TNI can be increased significantly in SIC, it is undoubted that it is more difficult to identify these two diseases.From objective evidence, the case is not completely diagnosed because of no coronary angiography and no typical shape of the echocardiography. The evidence is slightly deficient. More case reports are needed to confirm whether myocardial enzyme and TNI can be significantly elevated. It has great significance not only for the identification of the two diseases, but also for the current diagnostic criteria. It can reduce the misdiagnosis of the disease and have a better grasp of the choice of treatment. Similarly, in the Department of Endocrinology, we should pay more attention to the cardiac function of patients with DKA to prevent the occurrence of SIC.Ethical statementThis article does not contain any studies with human or animal subjects performed by any of the authors. The ethical statement is signed individually by all the authors.Conflict of interest statementWe declare that there is no conflict of interest in this article, and conflict of interest statement is signed individually by all the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical statement" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest statement" ] 2 => array:2 [ "identificador" => "xack428792" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial stunning due to simultaneous multivessel coronary spasm: a review of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Dote" 1 => "H. Sato" 2 => "H. Tateishi" 3 => "T. Uchida" 4 => "M. Ishihara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardiol" "fecha" => "1991" "volumen" => "21" "paginaInicial" => "203" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1841907" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and outcomes of Takotsubo (stress) cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Templin" 1 => "J.R. Ghadri" 2 => "J. Diekmann" 3 => "L.C. Napp" 4 => "D.R. Bataiosu" 5 => "M. Jaguszewski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "929" "paginaFinal" => "938" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Eliades" 1 => "D. El-Maouche" 2 => "C. Choudhary" 3 => "B. Zinsmeister" 4 => "K.D. Burman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2012.0384" "Revista" => array:6 [ "tituloSerie" => "Thyroid" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "383" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23560557" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Prasad" 1 => "A. Lerman" 2 => "C.S. Rihal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2007.11.008" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2008" "volumen" => "155" "paginaInicial" => "408" "paginaFinal" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294473" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack428792" "titulo" => "Acknowledgments" "texto" => "The authors are indebted to Shuai Jiang who from Internal Medicine-Cardiovascular Department, the First Clinical Hospital of Harbin Medical University, for helping us confirm the diagnosis." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015300000007/v1_201910040650/S0025775318307206/v1_201910040650/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015300000007/v1_201910040650/S0025775318307206/v1_201910040650/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318307206?idApp=UINPBA00004N"]

ISSN: 0025-7753

Medicina Clínica, fundada en 1943, es la única publicación semanal de contenido clínico que se edita en España y constituye el máximo exponente de la calidad y pujanza de la medicina española. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica. Los contenidos de Medicina Clínica abarcan dos frentes: trabajos de investigación original rigurosamente seleccionados atendiendo a su calidad, originalidad e interés, y trabajos orientados a la formación continuada, encomendados por la revista a autores relevantes (Editoriales, Revisiones, Conferencias clínicas y clínico-patológicas, Diagnóstico y Tratamiento). En estos artículos se ponen al día aspectos de destacado interés clínico o conceptual en la medicina actual. Medicina Clínica es un vehículo de información científica de reconocida calidad, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.

Ver más Opción Open Access

Indexada en:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, ScienceDirect