Silent Myocardial Infarction and Hypoglycaemia

Hypoglycemia can occur as a complication during the treatment of diabetes mellitus. The potential neurologic consequences of severe hypoglycemia, including coma and seizure, are well-recognized. Less commonly considered are possible cardiovascular complications associated with hypoglycemia. Myocardial ischemia and infarction are known to occur in the setting of hypoglycemia. We describe 4 cases of hypoglycemia associated with silent myocardial infarction. We explore the mechanisms by which hypoglycemia or the medications used to treat diabetes increase the risk of myocardial infarction. We also discuss how the stress of a recent myocardial infarction can elevate the risk of severe hypoglycemia. In view of this potential association, diabetic patients should be monitored closely for these 2 complications occurring sequentially in close temporal proximity.