Cardiovascular Complications of Hypoglycemia

Hypoglycemia is defined as low blood glucose levels. While it is uncommon in healthy adults, diabetics and other vulnerable patient populations remain at increased risk. The neuroglycopenic symptoms of hypoglycemia, such as dizziness, lethargy, loss of consciousness, etc., are well known. However, hypoglycemia has significant cardiovascular manifestations. During an acute hypoglycemic episode, sympathoadrenal activation causes increased epinephrine release. Epinephrine directly increases myocardial workload via stimulating β1 adrenoreceptors; in vulnerable populations, increased cardiac stress may provoke ischemia and infarction. Additionally, epinephrine may induce hypokalemia via stimulating β2 adrenoreceptors on various cells; electrolyte disturbances induce electrocardiogram changes, increasing the risk of cardiac arrhythmias. Endothelial dysfunction may also arise due to epinephrine-mediated adrenergic activation. This article reviews the current literature addressing pathogenesis, diagnostic criteria, and cardiovascular complications of hypoglycemia.