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Hypoglycemia-Induced Angina Pectoris in a Patient with Diabetes Mellitus
- Elia Duh, MD; and
- Mark Feinglos, MD
- From Duke University Medical Center, Durham, North Carolina. Requests for Reprints: Mark N. Feinglos, MD, Duke University Medical Center, Box 3921, Durham, NC 27710.
The effects of diabetes mellitus on the prevalence of coronary artery disease and myocardial infarction are well known, as are the common precipitators of angina pectoris—physical exertion, emotional stress, and digestion of a large meal. We describe a patient with diabetes mellitus in whom angina pectoris was typically precipitated by hypoglycemia.
Case Report
A 61-year-old white woman with diabetes was hospitalized for evaluation of chest pain induced by hypoglycemia. She had had myocardial infarctions in 1974 and 1980; she had been diagnosed with diabetes at age 47 and had been receiving insulin since that time. Her only other cardiac risk factor was hyperlipidemia; she had stopped smoking in 1980.
The patient reported exertional chest pain after 15 minutes of yard work; the pain was relieved by sublingual nitroglycerin and the patient dealt with the problem by reducing her workload. Of more concern for her was chest pain during episodes of hypoglycemia. Since her second myocardial infarction, which had occurred at approximately the same time that her diabetes was diagnosed, the patient had begun to have …
