Myocardial Injury without Electrocardiographic Changes after a Suicide Attempt by an Overdose of Glimepiride and Zolpidem: A Case Report and Literature Review

Abstract

A 40-year-old diabetic man was admitted to our hospital for poor glycemic control. During hospitalization, he took 42 mg glimepiride and 50 mg zolpidem as a suicide attempt. The following day, the creatine kinase-MB fraction and troponin I levels were elevated to 112 IU/L and 8.77 ng/mL, respectively, without any electrocardiographic abnormalities. The patient recovered completely without any complications. Four weeks later, coronary computed tomography angiography and myocardial perfusion scintigraphy revealed moderate one-vessel coronary disease without the evidence of myocardial ischemia or old infarction. Cardiac-specific markers must be considered in sulfonylurea-induced hypoglycemic patients, particularly when the patient is unconscious and does not exhibit any clinical manifestations.

What About Cardiotoxicity? An Evaluation of Cardiac Markers in Children with Suicidal Attempt by Drug Overdose

“…12 How-ever, cardiotoxicity due to suicide attempt by drug overdose has been reported in a few previous case reports and these reports included only one specific drug's effect and none of these cases were in pediatric age. 6,8,13 Hypothesized mechanisms for cardiac involvement were; drug's direct toxic effect to myocardium or indirect effect that could be explained by ischemic and metabolic changes due to drug overdose. 6,7 Another rare explanation is that suicide attempt might have important risk factors in development of stress cardiomyopathy named Takatsubo cardiomyopathy.…”

“…6,8,13 Hypothesized mechanisms for cardiac involvement were; drug's direct toxic effect to myocardium or indirect effect that could be explained by ischemic and metabolic changes due to drug overdose. 6,7 Another rare explanation is that suicide attempt might have important risk factors in development of stress cardiomyopathy named Takatsubo cardiomyopathy. 14 These reports showed evidence of cardiotoxicity by ECG changes and/or elevated cardiac enzymes and/or echocardiography.…”

“…Hepatotoxicity or nephrotoxicity following various drug toxications are well studied, however, data regarding cardiotoxicity is limited and reported in adults. [6][7][8] The possible mechanisms of cardiotoxicity could be described as; direct toxic myocarditis or metabolic changes and/or a part of multi organ system failure due to drug's effect. 7,9,10 The aim of this study is to evaluate the cardiac enzyme levels during the follow-up period in the hospital as well as to asses demographic, clinical and laboratory patterns of children who had suicidal attempt by drug overdose.…”