Cardiogenic Shock in Hypothyroidism

Abstract

A patient with minimal coronary artery disease presented in cardiogenic shock when her previously undiagnosed hypothyroid state was complicated by an episode of AV nodal re-entrant tachycardia. She did not respond to multiple pressors, and recovered dramatically after starting thyroid supplementation. Hypothyroidism caused her lack of responsiveness to pressors and perpetuated her hypotension and increased filling pressures long after she reverted to a sinus rhythm. Our case dramatically demonstrates the severe lack of physiologic reserve that can be associated with hypothyroidism.

Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support in a Patient with Panhypopituitarism: A Case Report

“…While there is considerable evidence supporting the pathophysiological role of thyroid hormone in chronic heart failure, there are comparatively few cases of thyroid deficiency contributing to acute heart failure or cardiogenic shock. Ashwath et al describe one patient with history of flutter who presented with cardiogenic shock that was precipitated by AV nodal re-entrant tachycardia secondary to previously undiagnosed primary hypothyroidism [9]. Dharmasena et al describe another patient, with no history of heart disease, who presented with global hypokinesia due to uncontrolled known primary hypothyroidism [10].…”

Cardiogenic shock in a patient with hypothyroid myopathy responsive only to thyroxin replacement: a case report

“…Hypothyroidism is associated with depressed chronotropy, increased peripheral vascular resistance, decreased cardiac contractility and decreased cardiac output and these effects are reversed with counteracting the hypothyroid state [4-6]. While cardiac dysfunction is well documented secondary to hypothyroidism, hypotension is rare and when it occurs it is resistant to conventional therapy in the form of intravenous fluids and vasopressors [7]. Hypothyroidism causes muscle relaxation and the isovolumetric relaxation and contraction time becomes prolonged and MPI increases indicating systolic and diastolic dysfunction [8].…”