Chest pain as a presentation of reactive hypoglycemia

Reported herein is a patient with multiple hospital admissions for atypical chest pain syndrome who underwent extensive noninvasive and invasive cardiologic testing to exclude ischemic heart disease as an etiology. During one episode of chest pain, the patient was found to have hypoglycemia with a blood sugar level of 46 ml/dl. Two subsequent oral glucose tolerance tests reproduced chest pain during hypoglycemia with values of 47 ml/dl and 27 ml/dl. The patient had previously had no significant clinical response to typical antianginal medications. Following evidence of concurrent hypoglycemia, the chest pain syndrome has significantly decreased with the patient on a low carbohydrate diet.