Coronary Vasospasm-Induced Myocardial Infarction: An Uncommon Presentation of Unrecognized Hyperthyroidism

Ataallah, Basma; Buttar, Barjinder S; Kaell, Alan; Kulina, Georgia; Kulina, Robert

doi:10.14740/jmc3473

Cited by 4 publications

(6 citation statements)

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“…AIT can be associated with cardiovascular complications, including rhythm disorders such as tachycardia and atrial fibrillation, along with high-output congestive heart failure, among others [ 15 , 16 ]. In more uncommon instances, it may also result in cardiac ischemia and acute myocardial infarction [ 6 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac Ischemia related to hyperthyroidism is rarely described in the literature and is the topic of older publications and a limited number of case reports [ 6 – 12 ]. It has been particularly described in elderly patients with coronary artery disease [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Amiodarone-induced hyperthyroidism may be associated to serious cardiac complications. In particular, hyperthyroidism can lead to cardiac ischemia and even to a secondary myocardial infarction [ 6 – 12 ]. In addition, hyperthyroidism is also associated with a pro-coagulant state and can aggravate cardiac and limb ischemia [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Aubry,

Dosch,

Donath

2024

J Med Case Reports

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Background Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism can precipitate cardiac complications, including cardiac ischemia and myocardial infarction, although this has only been described in a few case reports. Case presentation We present here a clinical scenario involving a 66-year-old male Caucasian patient under Amiodarone for atrial fibrillation, who developed AIT. In the presence of dyspnea, multiple cardiovascular risk factors and ECG abnormalities, a transthoracic echocardiogram was performed, showing inferobasal hypokinesia. This led to further investigations through a cardiac PET-CT, where cardiac ischemia was suspected. Ultimately, the coronary angiography revealed no abnormalities. Nonetheless, these extensive cardiologic investigations led to a delay in initiating an emergency endovascular revascularization for acute-on-chronic left limb ischemia. Although initial treatment using Carbimazole was not successful after three weeks, the patient reached euthyroidism after completion of the treatment with Prednisone so that eventually thyroidectomy was not performed. Endovascular revascularization was finally performed after more than one month. Conclusions We discuss here cardiac abnormalities in patients with AIT, which may be due to relative ischemia secondary to increased metabolic demand during hyperthyroidism. Improvement of cardiac complications is expected through an optimal AIT therapy including medical therapy as the primary approach and, when necessary, thyroidectomy. Cardiac investigations in the context of AIT should be carefully considered and may not justify delaying other crucial interventions. If considered mandatory, diagnostic procedures such as coronary angiography should be preferred to functional testing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Aubry,

Dosch,

Donath

2024

J Med Case Reports

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“…El hipertiroidismo se relaciona con elevación de la presión arterial sistólica, hipertensión pulmonar e insuficiencia de la válvula tricúspidea. En algunos casos se puede presentar con dolor torácico y alteraciones en el electrocardiograma, por aumento de la demanda de oxígeno, con signos y síntomas de insuficiencia cardiaca, y arritmias por hiperactividad de las células cardiacas, como taquicardia sinusal, aleteo y fibrilación auricular (6,7).…”

Section: Discussionunclassified

Dolor torácico y elevación del segmento ST en paciente de 21 años con hipertiroidismo en debut: Reporte de caso

et al. 2022

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La tirotoxicosis es un trastorno endocrino común que se presenta con una amplia variedad de síntomas sistémicos y que afectan el aparato cardiovascular (1). En la literatura, el hipertiroidismo se asocia a morbilidad y mortalidad cardiaca (2). Los síntomas relacionados con el aparato cardiovascular, como las palpitaciones o la angina, son una forma de presentación frecuente en los pacientes con hipertiroidismo. La estimulación adrenérgica, que se traduce en un aumento del gasto y contractibilidad cardiacas, puede inducir isquemia del miocardio (3), así como el vasoespasmo coronario transitorio que se informa hasta en el 20% de los pacientes con hipertiroidismo (4) y el efecto antagónico del calcio en el miocardio (5). En esta revisión se presenta el caso de un paciente joven, sin antecedentes patológicos de importancia que consulta al servicio de urgencias por cuadro de dolor torácico, con electrocardiograma que muestra elevación del segmento ST, sin embargo, con cateterismo cardiaco que reporta coronarias sanas y ecocardiograma que evidencia trastorno segmentario de la contractilidad y disminución de la fracción de eyección del ventrículo izquierdo, atribuida a vasoespasmo coronario, por tirotoxicosis basado en los hallazgos de exámenes de laboratorio.

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“…Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a recently introduced terminology to describe around 5%–10% of MI patients with patent coronary arteries 1. One cause of MINOCA is coronary artery spasm, which has a range of potential causes including thyroid dysfunction 2. Thyroid storm is an acute life-threatening medical emergency that occurs due to high circulating levels of thyroid hormones released from the thyroid glands.…”

Section: Introductionmentioning

confidence: 99%

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

Omar

Knott²,

Saba³

et al. 2023

BMJ Case Rep

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A man in his 40s who was previously well had an out-of-hospital cardiac arrest. Postresuscitation ECG showed ST-elevation myocardial infarction (MI). Emergency coronary angiogram revealed MI with non-obstructive coronary arteries (MINOCA) with evidence of spasm in the right coronary artery. Both his echocardiogram and cardiac MRI revealed a normal heart. Further workup showed markedly elevated free T4 (99.5 pmol/L) and free T3 (26.7 pmol/L) with low thyroid stimulating hormone (<0.02 pmol/L) in keeping with thyroid storm. He also had an elevated adjusted calcium level (2.84 mmol/L), which could have contributed to his coronary artery spasm. His peak troponin T was elevated at 798 ng/L (<14) suggesting myocardial damage. He was treated with propylthiouracil, steroids, beta-blocker, calcium channel blocker and intravenous fluids. The patient achieved a full recovery and was discharged home. This is an unusual case of thyroid dysfunction resulting in coronary artery spasm, cardiac arrest and MINOCA.

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Coronary Vasospasm-Induced Myocardial Infarction: An Uncommon Presentation of Unrecognized Hyperthyroidism

Cited by 4 publications

References 6 publications

Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Dolor torácico y elevación del segmento ST en paciente de 21 años con hipertiroidismo en debut: Reporte de caso

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

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