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A 33-year-old woman with newly diagnosed disseminated tuberculosis presented with acute heart failure and incidental findings of intracardiac thrombus, demonstrating possible tuberculous myocarditis. (Level of Difficulty: Intermediate.), Central Illustration

Objectives. A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH. Methodology. We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD. Results. A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029). Conclusion. In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.

BackgroundHistory of severe hypoglycemia (SH) has been associated with cardiovascular (CV) events among patients with type II diabetes mellitus (T2DM). In this study, we screened patients with SH for atherosclerotic coronary artery disease (ACAD) .MethodsWe conducted a matched case-control study involving 28 T2DM patients with SH within the last 5 years with no documented ACAD and matched them with 28 T2DM patients with no SH. All subjects underwent coronary artery calcium scoring (CACS) followed by CT coronary angiography (CCTA) if indicated.ResultsHistory of SH in T2DM was associated with 78% (22 out of 28) incidence of significant ACAD compared to 46% (13 out of 28) in those without SH, based on either CACS≥400, or at least one coronary artery with ≥50% stenosis from CCTA, ( P =0.026).ConclusionThis study supported that SH in T2DM is associated with ACAD compared to T2DM without SH.