Cardiac arrest in myocardial infarction with non-obstructive coronary artery (MINOCA) secondary to thyroid dysfunction

Omar, Ahmed Moemen A; Knott, Kristopher; Saba, Magdi; Lim, Pitt

doi:10.1136/bcr-2022-253500

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Therefore, during coronary angiography, the administration of intracoronary nitroglycerin serves as a valuable diagnostic tool in distinguishing vasospasm from atherosclerotic coronary artery disease and avoiding unnecessary stenting [9][10][11]. Thyrotoxicosis-induced coronary vasospasm may lead to severe outcomes, including cardiac arrest and necessitating resuscitation, as reported by Omar et al [13]. Moreover, a patient experiencing a thyroid storm has been reported to develop spontaneous coronary artery dissection (SCAD), which is another causative factor of ACS to remember.…”

Section: Discussionmentioning

confidence: 98%

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Širvys,

Baranauskas,

Budrys

2024

JCM

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Coronary artery vasospasm plays a crucial role in the prevalence of unstable angina. Despite common misdiagnosis, there is limited evidence on this topic. Here, we present a rare case of unstable vasospastic angina in a female with severe thyrotoxicosis. Case Report: A 62-year-old female patient was admitted to the cardiac intensive care unit due to crushing chest pain at rest. The patient exhibited ischemic changes on the ECG with a normal troponin I level. Recurrent chest pain prompted urgent coronary angiography, revealing generalized vasospasm of all coronary artery branches including the left main coronary artery. Intracoronary nitroglycerin injection partially alleviated the vasospasm; however, there was a persistent stenosis in the left main artery. Subsequent intravascular ultrasound demonstrated an anatomically normal left main artery. Post-procedure, laboratory tests revealed undetectable levels of thyroid-stimulating hormone and thyroid hormones above the detectable level. The patient was initiated on methimazole and discharged symptom-free, expecting a good prognosis under conservative management. Conclusions: Clinically significant coronary vasospasm triggered by thyrotoxicosis remains a rarity in clinical practice, often posing diagnostic challenges. This case emphasizes the significance of intracoronary nitroglycerin and intravascular ultrasound in discerning the etiology of coronary lesions seen on angiography. We advocate for these techniques to optimize invasive coronary artery diagnostics, enabling the selection of the appropriate treatment strategies and improving long-term prognosis.

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Section: Discussionmentioning

confidence: 98%

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Širvys,

Baranauskas,

Budrys

2024

JCM

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“…TS-induced ventricular fibrillation (VF)/sudden cardiac death (SCD): A few cases of TS-induced SCD have been described in the literature [70,181,182,224]. The rate of death due to cardiac arrest increases significantly within a short timeframe in patients with TS, particularly in the presence of coexisting coronary artery disease [249].…”

Section: Discussionmentioning

confidence: 99%

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Elmenyar,

Aoun,

Al Saadi

et al. 2023

Diagnostics

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Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch–Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.

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Angina: The Ischemic Triad

Lim

2024

The American Journal of Cardiology

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Cardiac arrest in myocardial infarction with non-obstructive coronary artery (MINOCA) secondary to thyroid dysfunction

Cited by 3 publications

References 24 publications

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Angina: The Ischemic Triad

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