Severe hypoglycemia due to insulin self-injection as a cause of acute ST elevation myocardial infarction
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The role of hypoglycemia in cardiovascular disease still needs to be evaluated. Incidental case studies provide direct, but so far limited, evidence for the direct impairment of heart caused by hypoglycemia. We present a case of severe hypoglycemia manifesting with acute ST elevation myocardial infarction (STEMI).
A 48-year old man committed a suicidal attempt by insulin self-injection. The emerged hypoglycemia was accompanied by ECG changes and positive troponins confirming the diagnosis of STEMI. Urgent coronary angiography was performed, but no acute coronary artery closure/critical stenosis was found. After resolution of hypoglycemia all signs of ischemia diminished. Insulin and C-peptide levels confirmed exogenous hyperinsulinemia, confirming insulin self-injection. Sadly, the patient suffered irreversible brain damage.
This patient case shows that severe hypoglycemia can precipitate acute STEMI.
KeywordsHypoglycemia STEMI Insulin self-injection Suicide
Jakub Benko and Tomáš Bolek share first authorship, Matej Samoš and Marián Mokáň share last authorship, they contributed equally to this work. This study was supported by research project APVV (Slovak Research and Development Agency) 16-0020.
This study was funded by research project APVV (Slovak Research and Development Agency) 16–0020.
Compliance with ethical standards
Conflict of interest
Jakub Benko, Tomáš Bolek, Dana Prídavková, Peter Galajda, Matej Samoš, and Marián Mokáň declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.
Ethical approval and inform consent
This research was done according to ethical standards. The patient relatives (as patient suffered irreversible brain damage and was not able to sign any form) agreed to participate in the research and to publish this case study and signed informed consent for study participation.
- 1.Gerstein HC, Miller ME, Byington RP et al.; Action to control cardiovascular risk in diabetes study group. (2008) effects of intensive glucose lowering in type 2 diabetes. N Engl J Med; 358: 2545–2559.Google Scholar