Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Med Intensiva 2017;41:261 - Vol. 41 Num.4 DOI: 10.1016/j.medine.2016.12.002
Letter to the Editor
Author's reply
Respuesta de los autores
M. García-Delgado, , I. Navarrete-Sánchez
Unidad de Cuidados Intensivos, Complejo Hospitalario Universitario de Granada, Granada, Spain
Dear Editor,

We appreciate both the interest of Dr. Madías in our article1 and the interesting contributions made. Diabetic patients could have a lesser prevalence of Takotsubo syndrome in relation to secondary autonomic neuropathy and adrenal gland catecholamine hyposecretion.2 Our patient was diagnosed with diabetes mellitus approximately four years before her current admission, and her history revealed no secondary complications such as vascular disease or peripheral neuropathy. On the other hand, the lesser voltage or attenuation of the QRS complexes of the ECG-A (Fig. 2 in our article) has a range of possible causes that have been well described in the literature,3 such as myocardial and pulmonary edema, pericardial effusion, pneumomediastinum, hypoalbuminemia, water overload, etc.—all frequently present in the postoperative period of heart surgery. Attenuation of the QRS complexes gradually subsided with resolution of the clinical condition and over the days following surgery, as can be seen in ECG-B, recorded on day 10 of the clinical course.

References
1
García-Delgado M, García-Huertas D, Navarrete-Sánchez I, Olivencia-Peña L, Garrido JM. Soporte con oxigenación de membrana extracorpórea en un síndrome de Takotsubo y QT largo tras cirugía cardiaca. Med Intensiva. in press, 2016. pii: S0210-5691(16)30152-8. doi: 10.1016/j.medin.2016.07.007
2
A. Dias,E. Franco,M. Rubio,N. Koshkelashvili,V. Bhalla,S. Amanullah
Takotsubo syndrome: does it matter if you have diabetes mellitus?
Int J Cardiol, 224 (2016), pp. 398-399 http://dx.doi.org/10.1016/j.ijcard.2016.09.048
3
J.E. Madias
Low QRS voltage and its causes
J Electrocardiol, 41 (2008), pp. 498-500 http://dx.doi.org/10.1016/j.jelectrocard.2008.06.021

Please cite this article as: García-Delgado M, Navarrete-Sánchez I. Respuesta de los autores. Med Intensiva. 2017;41:261.

Corresponding author. (M. García-Delgado mjgardel@hotmail.com)
Copyright © 2017. Elsevier España, S.L.U. and SEMICYUC
Med Intensiva 2017;41:261 - Vol. 41 Num.4 DOI: 10.1016/j.medine.2016.12.002