Acute myocardial infarction as a complication of diabetic neuropathy

ALTHOUGH autonomic neuropathy is common in diabetes, clinically troublesome orthostatic hypotension caused by the involvement of the vasomotor system is not frequently observed. Distinctly unusual is postural hypotension severe enough to precipitate a myocardial infarction, as in our patient's case. Report of a Case A 60-year-old woman with mild diabetes treated with tolbutamide was admitted to the hospital for recurrent episodes of loss of consciousness and disturbances in micturition. She complained of dizziness while sitting. Her pulse rate was 84 beats per minute, and her blood pressure was 140/80 mm Hg, supine. The ECG was normal. The abdomen was distended, and the sphincter ani was atonic. She had diabetic retinopathy, and her ankle and patellar reflexes were absent. On the day after admission, the patient lost consciousness as her blood pressure dropped precipitously when she stood up. She regained consciousness promptly on lying down, but complained of a pressure sensation