# Takotsubo cardiomyopathy associated with pneumatosis cystoides intestinalis and postprandial hypoglycemia of anorexia nervosa

## TL;DR

A patient with anorexia nervosa and intestinal cysts developed heart issues after severe low blood sugar, highlighting the need for quick diagnosis.

## Contribution

This case report links postprandial hypoglycemia in anorexia nervosa with takotsubo cardiomyopathy and intestinal pneumatosis.

## Key findings

- A 48-year-old woman with anorexia nervosa and PCI developed TCM after hypoglycemic coma.
- PCI may worsen hypoglycemia in anorexia nervosa, leading to TCM.
- Clinicians should consider TCM when hypoglycemia is followed by chest pain and hypotension.

## Abstract

Hypoglycemia is not rare in anorexia nervosa (AN). Takotsubo cardiomyopathy (TCM) is characterized by extensive akinesis of the apical region with hypercontraction of the basal segment of the ventricle in the absence of coronary artery disease. Its mechanism is not fully understood, but hypoglycemia is considered one of the physical factors. Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gaseous cysts in the intestinal wall. PCI sometimes causes an absorption defect. The case of a 48‐year‐old woman with AN with PCI and TCM that developed after a postprandial hypoglycemic coma is reported. When the patient was admitted to our hospital, her abdominal X‐ray showed a confluent image of grapes, and computed tomography showed gaseous cysts in the intestinal wall from the ascending colon to the transverse colon. PCI was then diagnosed. About 7 days after admission, she developed hypoglycemic coma. However, she recovered from the coma and on the next day she became suddenly hypotensive, with the electrocardiogram showing T‐wave inversion. Echocardiography then showed akinesis around the apex and hypercontraction of the basal segments, and TCM was diagnosed. Severe AN with PCI may cause more severe hypoglycemia, resulting in TCM.

A patient with anorexia nervosa with pneumatosis cystoides intestinalis developed takotsubo cardiomyopathy after a postprandial hypoglycemic coma. When chest pain and dyspnea with hypotension develop after hypoglycemia, clinicians should consider the possibility of takotsubo cardiomyopathy and perform electrocardiography and echocardiography quickly.