Abstract
We report a diabetic patient who developed induced acute heart failure after initiation of insulin treatment.
A 64-year-old woman with type 2 diabetes mellitus developed acute heart failure about 3 months after initiation of insulin treatment. When HbA1c had improved from 14.6% to 8.7%, she developed pretibial edema, pedal edema and effort dyspnea with a weight gain of 12 kg to 48 kg. Chest X ray showed marked cardiomegaly and bilateral pleural effusion. The cardiothoracic ratio (CTR) increased from 43% to 66%. Electrocardiography was normal and BNP levels rose markedly to 477 pg/ml. Doppler echocardiography showed severely reduced systolic and diastolic functions (restrictive pattern) and moderate pericardial effusion. Fourteen days after administration of digitalis and a diuretic, pretibial edema and pleural effusion in chest radiography disappeared. Follow-up ultrasonic cardiography taken two months later showed that the ejection fraction (EF) remained at 35% and the restrictive pattern was unchanged. Before the onset of heart failure, the resting and loaded radionuclide angiography showed no deficit in blood supply to the heart muscles and no ischemic heart disease although the EF of 37% preexisted. We surmise that the mechanism of heart failure was chronic abnormal myocardial stiffness due to diabetic toxicity and acute body fluid retention as a direct effect of insulin.
