Anjum Reema, Virk Hafeez Ul Hasan, Goyfman Michael, Lee Alexander, John Geevarghese
Internal Medicine, Northwell Health-Long Island Jewish Forest Hills Hospital, New York, USA.
Department of Cardiovascular Diseases, Einstein Heart and Vascular Institute, New York, USA.
Cureus. 2022 Jun 28;14(6):e26408. doi: 10.7759/cureus.26408. eCollection 2022 Jun.
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.
甲状腺毒症可因冠状动脉痉挛导致急性胸痛，而心电图无ST段改变。其诊断可能极具挑战性，因为症状可能类似急性冠状动脉综合征。冠状动脉痉挛的诊断通过冠状动脉造影得以证实。冠状动脉内使用硝酸甘油可缓解痉挛并揭示冠状动脉疾病的真实程度。我们报告一例围绝经期妇女，新诊断为甲状腺功能亢进症，出现胸痛。冠状动脉造影显示左前降支动脉痉挛，冠状动脉内使用硝酸甘油后痉挛缓解。甲状腺功能亢进症与一系列心血管表现相关，从相对良性的心悸到心脏骤停。甲状腺功能亢进症很少与发作性心绞痛相关，这表明继发于冠状动脉痉挛的心肌缺血。甲状腺毒症诱发的冠状动脉痉挛是一种罕见病症。冠状动脉痉挛可能伪装成急性冠状动脉综合征，通常需要冠状动脉造影以排除心肌梗死。在有发生甲状腺毒症诱发冠状动脉痉挛风险因素的患者中，冠状动脉造影发现的任何狭窄不能仅被认为是冠状动脉疾病，必须探究冠状动脉痉挛的可能性。我们的病例强调在这些患者中使用术中硝酸甘油，它可缓解痉挛并揭示冠状动脉疾病的真实程度。恢复甲状腺功能正常是治疗的基石，可减少长期使用冠状动脉血管扩张药物的必要性。对这些患者进行早期诊断和优化管理可带来良好的预后。
