A Therapeutic Challenge of STEMI with concurrent DKA in Emergency Department

Abstract

Diabetic ketoacidosis (DKA) with acute ST-elevation myocardial infarction (STEMI) is rare but associated with significantly increased mortality and morbidity. We report a case of a 58-year-old woman with poorly controlled diabetes mellitus (HbA1c 18.1%) who presented with chest pain and was found to have inferior STEMI and DKA. Despite thrombolysis, she developed ventricular fibrillation and succumbed before rescue percutaneous coronary intervention (PCI) could be performed. This case illustrates the diagnostic and therapeutic challenges in managing coexisting DKA and STEMI, particularly in resource-limited settings. High HbA1c, lactic acidosis, and volume overload were contributing factors to poor outcomes. Fluid resuscitation, a mainstay of DKA management, must be balanced against the risk of exacerbating cardiac dysfunction. Early recognition, multidisciplinary coordination, bedside ultrasound for fluid assessment, and timely access to PCI-capable centres are essential for improving survival. Policy efforts should aim to expand STEMI network service hours to provide equitable care for critically ill patients presenting outside standard operational times.