A Case With Thyrotoxic Cardiomyopathy and ECGImaging Resembling an Acute Coronary Syndrome

The case described here concerns to a femail aged 52 yr with history of Graves’disease which has been diagnosed 6 yr ago, not correctly controlled. For reason of rapid worsening she was admitted to hospital with data of severe congestive heart failure (gr 4), sinus tachycardia and ECG voltage imaging resembling an acute coronary syndrome – ST elevation and negative T waves in dynamic of the standard, V1,V2,V3, AVF. Clinical study and US established diffuse goiter gr 3 (by ETA), TED cl.2-b and laboratory data for the advanced autoimmune hyperthyroidism. The selective coronarography undertaken in emergency revealed a normal blood flow of the main left, the left anterior descending and the right coronary arteries without any data of occlusion Prinzmetal angina as well as Takotsubo syndrome. Echocardiography revealed a mitral valve prolapse, regurgitation gr 3 and thickened mitral leaflets. The systolic pressure of pulmonary artery was elevated up to 60 mm Hg. After intensive therapy with methimazole of 50 mg/d, nebivolol 5 mg d., saline infusions, Potassium chloride and oxygen supply ECG abnormalities disappeared within 2-3 weeks which corresponded to rapid clinical improved, reduction of mitral regurgitation up to 1-2 gr and decrease of FT3, FT4 to reference range after 6 weeks.

 

The patient described demonstrates a severe thyrotoxic cardiomyopathy in which the acute hormonal excess provokes extreme oxygene demands as a cause of atypical myocardial ischemia mimicking an acute myocardial infarction despite of the normal coronary flow. The similar complication was rare and reversible in result of high doses thionamides and intensive treatment of cardio-pulmonary failure.