الفهرس 
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Abstract
Introduction:. Severe hypoglycemia is recognized to be one of the strongest predictors of cardiovascular morbidity and mortality especially in patients with type 2 diabetes. However, it is uncertain whether a direct pathophysiological link exists or whether hypoglycemia is primarily a marker of vulnerability to these events (Hanefeld, et al., 2016). Several cardiovascular effects occur during hypoglycemia either as a result of low blood glucose levels per se or through activation of the sympathoadrenal response: hemodynamic changes with an increase in cardiac work load and potential attenuation of myocardial perfusion, electrophysiological changes that may be arrhythmogenic, induction of a prothrombotic state, and release of inflammatory markers (Davis, et al., 2017). The aim of work: The aim of this study is to elucidate the influence of acute hypoglycemia on the cardiovascular system: whether it is ischemic or arrhythmogenic in the emergency department and its relation to sudden cardiac arrest. Research Plan:. The present study included 102 patients; without history of IHD; who were divided into 2 groups: group 1 which included 50 individuals with euglycemic state as a control group and group 2 which included 52 patients with hypoglycemic state. group 2 was further subdivided into two subgroups: group A which included 18 hypoglycemic patients with ischemic myocardial changes and group B which included 34 hypoglycemic patients without ischemic myocardial changes. Results: On comparison between the two hypoglycemic subgroups, we found that troponin levels were within the normal range between the two subgroups which exclude the presence of myocardial infarction as a complication of hypoglycemia in the hypoglycemic patients. RBG and Potassium levels were obviously lower in group A; which had myocardial changes; than group B which showed no changes. ECG changes that appeared in group A patients included in the following order: RR interval changes in all cases, then T wave (flattening or inversion), then arrhythmias, then PR interval shortening, then QTc prolongation, then ST depression. The types of arrhythmias appeared during hypoglycemia included sinus tachycardia, then NSVT, then PVC, sinus bradycardia, sustained pulsed VT then CHB. All ECG changes resolve after hypoglycemia correction. Conclusion:. Based on our results, we conclude the following: o Acute hypoglycemia may induce temporary myocardial ischemia as proved by ECG changes. o RBG is directly proportional to Potassium level. The lower the plasma glucose level, the lower the Potassium level, the more QTc prolongation, the higher the incidence of arrhythmias [ventricular (VT: non-sustained or sustained), sinus bradycardia and CHB]. o All ECG changes occurring with acute hypoglycemic episodes are reversible and resolve on restoration of normal plasma glucose level.