Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK.
BMJ Case Rep. 2023 Feb 10;16(2):e253500. doi: 10.1136/bcr-2022-253500.
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.
一位 40 多岁的既往体健男性发生院外心脏骤停。复苏后心电图显示 ST 段抬高型心肌梗死（STEMI）。急诊冠状动脉造影显示非阻塞性冠状动脉疾病伴右冠状动脉痉挛引起的心肌梗死（MINOCA）。他的超声心动图和心脏 MRI 均显示心脏正常。进一步检查发现游离 T4（99.5 pmol/L）和游离 T3（26.7 pmol/L）显著升高，促甲状腺激素（<0.02 pmol/L）降低，符合甲状腺危象。他的校正钙水平也升高（2.84 mmol/L），这可能导致了他的冠状动脉痉挛。他的肌钙蛋白 T 峰值升高至 798 ng/L（<14），提示心肌损伤。他接受了丙硫氧嘧啶、类固醇、β受体阻滞剂、钙通道阻滞剂和静脉补液治疗。患者完全康复并出院回家。这是一个不常见的甲状腺功能障碍导致冠状动脉痉挛、心脏骤停和 MINOCA 的病例。
