Myocardial infarction with acute insulin poisoning - A case report

A 36-year-old woman without overt coronary risk factors was admitted to hos pital with coma about 9 hours after mass self-injection of insulin (1,500 u nits). Laboratory investigation revealed severe hypoglycemia and hyperinsul inemia. During the treatment of her hypoglycemia, circulatory collapse occu rred. The EGG, echocardiogram, and elevation in troponin T suggested a diag nosis of myocardial infarction. Although the patient became apallic and dev eloped systemic spasticity due to hypoglycemic brain damage, her hemodynami cs improved with supportive care alone. Coronary angiography and myocardial scintigraphy performed later demonstrated a broad area of myocardial damag e despite intact coronary artery circulation. The authors hypothesize that temporary coronary arterial narrowing or coronary arterial vasospasm induce d by severe hyperinsulinemia contributed to the pathogenesis of the myocard ial infarction. The possibility of myocardial infarction should be consider ed in patients with acute insulin poisoning.