Nonischemic Anterior and Inferior Wall Stunning in the Setting of Severe Diabetic Ketoacidosis

A28-year-old woman presented with nausea, vomiting, and altered mental status. Electrocardiography (ECG) revealed only sinus tachycardia. Diabetic ketoacidosis was diagnosed. She was given a rapid infusion of saline and insulin, anti-inflammatory medications, and a small dose of intravenous sodium bicarbonate; she remained under observation. An ECG performed 1 hour later revealed a pattern of anterior and inferior wall injury (Fig. 1). Subsequent cardiac marker studies suggested myocardial injury. However, minimal wall-motion abnormality was observed on physiologic testing, and the patient experienced a rapid recovery, including complete normalization of the ECG.

Fig. 1 Electrocardiogram, obtained during peak abnormality, shows anteroapical and inferior wall injury and ventricular bigeminy.

This case demonstrates nonischemic stunning of the anterior and inferior wall in the setting of severe diabetic ketoacidosis, a condition with which takotsubo cardiomyopathy, or nonischemic apical stunning, has not been closely associated.