SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Recurrent Stress Cardiomyopathy Triggering Cardiogenic Shock

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This case describes a 60-year-old woman with poorly controlled type 2 diabetes who presented with chest pain, nausea, vomiting, DKA, and multifocal pneumonia. She had a prior episode of stress cardiomyopathy during DKA with full recovery of heart function. On this admission, labs confirmed DKA and her troponin rose significantly, raising concern for myocardial injury. Although her initial ECG showed no ischemic changes and prior coronary angiography had shown no significant coronary artery disease, bedside and formal echocardiography revealed reduced left ventricular systolic function with apical and mid-ventricular akinesis, consistent with recurrent stress cardiomyopathy.<br /><br />Her clinical course was complicated by pulmonary edema and cardiogenic shock physiology, requiring ICU care, diuresis, and vasoactive support with nitroprusside and milrinone. As her DKA and pneumonia improved, she was transitioned to guideline-directed heart failure therapy including lisinopril and carvedilol. A repeat echocardiogram before discharge showed recovery of left ventricular ejection fraction to 52% with improved apical function, and she was discharged in stable condition on hospital day 8.<br /><br />The report emphasizes that takotsubo (stress) cardiomyopathy should be considered in patients with DKA who develop troponin elevation, heart failure, or cardiogenic shock, especially when coronary artery disease is absent. It also highlights that DKA can trigger recurrent stress cardiomyopathy, a phenomenon rarely documented in the literature.

Asset Subtitle

Kevin Stanko

Meta Tag

Author List Christina Moe, Jacob Jentzer, Kevin Stanko, Samuel B. Huxley

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Diabetic Ketoacidosis

Concept Left Ventricular Systolic Dysfunction

Concept Myocardial Injury

Concept Heart Failure

Distinguished Non-Finalist

Presenter Organization Mayo Clinic School of Graduate Medical Education

Presenting Author Kevin Stanko

Track Adult

Keywords

takotsubo cardiomyopathy

stress cardiomyopathy

diabetic ketoacidosis

type 2 diabetes

troponin elevation

cardiogenic shock

left ventricular dysfunction

apical akinesis

multifocal pneumonia

coronary artery disease

Takotsubo Cardiomyopathy

Diabetic Ketoacidosis

Left Ventricular Systolic Dysfunction

Myocardial Injury

Heart Failure