A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis

Khoo, Serena; Chu, Chong Mow; Fung, Yin Khet

doi:10.1155/2018/4827907

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…Coronary artery disease is heterogeneous and clinical presentation varies; therefore, it can be related to chronic coronary syndrome, unstable angina, acute myocardial infarction with or without ST segment elevation or sudden death [ 25 , 26 ]. Even paradoxical cases without chest pain with myocardial infarction have been reported in the context of thyrotoxicosis [ 27 ]. Patients may present with cardiovascular complications such as ventricular or supraventricular arrhythmias, hemodynamic instability, cardiogenic shock and cardiorespiratory arrest [ 28 ].…”

Section: Hyperthyroidism and Coronary Artery Diseasementioning

confidence: 99%

Cardiac manifestations in hyperthyroidism

Navajas¹,

Cruz²,

Ordoñez³

et al. 2022

Rev. Cardiovasc. Med.

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Thyroid hormones have a fundamental impact on cardiac function that is mediated by genomic and nongenomic effects, alterations that condition physiological repercussions that lead to changes in frequency, contractility, rhythm and cardiac output as well as an increase in the incidence and prevalence of different cardiovascular diseases. This document presents an updated review of the implications that hyperthyroidism has in different cardiac conditions, including its importance in the evaluation of perioperative cardiovascular risk.

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Section: Hyperthyroidism and Coronary Artery Diseasementioning

confidence: 99%

Cardiac manifestations in hyperthyroidism

Navajas¹,

Cruz²,

Ordoñez³

et al. 2022

Rev. Cardiovasc. Med.

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“…The best way to promptly diagnose this condition is to have a high index of suspicion in patients with positive risk factors for this condition. These include female gender [18], age 45 to 75 years [18], Asian ethnicity [8], smoking [19], and intake of vasoconstrictive medications such as Sumatriptan [6]. Other clues include personal history of treated or untreated hyperthyroidism, positive family history, and careful physical examination to look for goiter, thyroid bruit, lid lag, fine tremors, and palpitations [10].…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxicosis-Related Left Main Coronary Artery Spasm Presenting As Acute Coronary Syndrome

Anjum¹,

Virk²,

Goyfman³

et al. 2022

Cureus

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Thyrotoxicosis can cause acute chest pain without ST changes in EKG due to coronary artery spasm. Its diagnosis can be particularly challenging as the symptoms may mimic acute coronary syndrome. The diagnosis of coronary artery spasm is confirmed by coronary angiography. The use of intracoronary nitroglycerin can relieve spasms and reveal the true extent of coronary artery disease.We present a case of a perimenopausal woman with newly diagnosed hyperthyroidism who presented with chest pain. Coronary angiography showed spasm of the left anterior descending artery which was relieved by intracoronary nitroglycerin.Hyperthyroidism is associated with a spectrum of cardiovascular manifestations ranging from relatively benign palpitations to cardiac arrest. Rarely, it has been associated with episodic angina which indicates myocardial ischemia secondary to coronary artery spasm. Thyrotoxicosis-induced coronary artery spasm is a rare condition. Coronary artery spasm might masquerade as acute coronary syndrome, and coronary angiography is usually necessary to rule out myocardial infarction. In patients with risk factors for developing thyrotoxicosis-induced coronary artery spasm, any stenosis found on coronary angiography must not be assumed to be coronary artery disease only, and the possibility of coronary artery spasm must be explored. Our case emphasizes the use of intraprocedural nitroglycerin in these patients, which can relieve the spasm and reveal the true extent of coronary artery disease. Restoration of euthyroidism is the cornerstone of management and abates the need for long-term coronary vasodilator medications. Early diagnosis and optimal management have a favorable prognosis in these patients.

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Unusual Presentations of Thyrotoxic Tricuspid and Mitral Regurgitations in 62 Adults: A Systematic Review of Case Reports with In-depth Pathophysiological Review

Witarto,

Pramudito

et al. 2024

Eur Cardiol

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Background: Thyrotoxicosis is related to cardiovascular mortality. This can be caused by several clinical manifestations involving the rare provocation of tricuspid regurgitation (TR) and mitral regurgitation (MR). However, there are still no clear data on thyrotoxic TR and/or MR. This study examines the progression of TR, MR, heart failure (HF) and pulmonary hypertension (PH) in response to the thyrotoxic heart manifestations, clinical characteristics and treatment approaches. Methods: A PRISMA-based systematic search was conducted using PubMed and other databases up to 17 June 2023. The outcomes of this study were TR, MR, HF and PH with their progression on follow-up, clinical characteristics and treatment approaches. Results: A total of 57 case reports involving 62 patients (45.77 ± 13.41 years) were included in this study. They were predominantly women (n=50; 80.65%) and diagnosed with Graves’ disease (n=41; 75.81%). All patients were diagnosed with thyrotoxicosis, and this included 23 (37.10%) cases of thyroid storm. From echocardiographic studies, several patients improved clinically within the first 6 months of follow-up, including 20 TR patients (83.33%) in 6 months, nine MR patients (69.23%) in 3 months, eight HF patients (66.67%) in 2 months and 16 PH patients (76.19%) in 6 months. Conclusion: Several mechanisms are involved in thyrotoxic TR and/or MR, including the direct thyroid hormone effect and the indirect effect of other hyperthyroidism-associated factors. Patients with thyrotoxic TR and/or MR, including those with HF and PH, can experience clinical and structural improvements following hyperthyroidism treatment in the first 6 months.

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A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis

Cited by 3 publications

References 11 publications

Cardiac manifestations in hyperthyroidism

Cardiac manifestations in hyperthyroidism

Thyrotoxicosis-Related Left Main Coronary Artery Spasm Presenting As Acute Coronary Syndrome

Unusual Presentations of Thyrotoxic Tricuspid and Mitral Regurgitations in 62 Adults: A Systematic Review of Case Reports with In-depth Pathophysiological Review

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