Naderi Fatemeh, Naderi Narges, Mousavinezhad Seyedeh Maryam, Zadeh Amin Zaki
Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Valiasr Street, Tehran, 1995614331, Iran.
Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Emerg Med. 2024 Sep 4;17(1):111. doi: 10.1186/s12245-024-00695-1.
Myocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the heart due to hyperstimulated thyroid function.
The patient was a 36-year-old woman who presented with left-sided chest pain, dyspnea, palpitation, and tremor. The initial evaluation showed evidence of myocardial ischemia (positive high-sensitivity troponin) caused by a hyperactive thyroid gland. The treatment for myocardial infarction, along with anti-thyroid medications, improved the patient's condition and subsided the symptoms. The coronary angiography revealed no pathologic finding, and the hypokinetic left ventricle, observed in the first echocardiogram, was resolved. The patient was discharged with an excellent clinical condition, and after the 4-month taking of a calcium channel blocker and tapering carbimazole, the thyroid function became normal, and her symptoms resolved completely.
Patients without evident risk factors for ischemic heart disease, such as non-diabetic, nonsmoker, and young individuals who presented with acute coronary syndrome, should be evaluated for a potential background reason for the imbalance between the oxygen demand and supply of the myocardium. The presence of palpitation, weight loss, tremors, insomnia, and anxiousness, along with ischemic signs, should make the physician think about the probability of the hyperthyroid-induced cardiovascular disorder.
The initial presentation of hyperthyroidism might be accompanied by severe cardiac symptoms. When the demographic features are not aligned with usual ischemic heart disease, other probable symptoms and signs should be investigated, and thyroid function should be checked. The control of thyroid hyperactivity would result in the resolution of both cardiac and non-cardiac symptoms.
心肌缺血可由多种原因引起，这些原因导致心肌氧供需失衡。这种情况的一个潜在原因是甲状腺功能亢进导致心脏过度工作。
患者为一名36岁女性，表现为左侧胸痛、呼吸困难、心悸和震颤。初步评估显示存在由甲状腺功能亢进引起的心肌缺血证据（高敏肌钙蛋白阳性）。心肌梗死的治疗以及抗甲状腺药物改善了患者的病情并缓解了症状。冠状动脉造影未发现病理改变，首次超声心动图观察到的左心室运动减弱也得到缓解。患者出院时临床状况良好，在服用钙通道阻滞剂和逐渐减少甲巯咪唑剂量4个月后，甲状腺功能恢复正常，症状完全消失。
对于无明显缺血性心脏病危险因素（如非糖尿病、不吸烟且年轻）却出现急性冠状动脉综合征的患者，应评估心肌氧供需失衡的潜在背景原因。出现心悸、体重减轻、震颤、失眠和焦虑以及缺血体征时，医生应考虑甲状腺功能亢进引起的心血管疾病的可能性。
甲状腺功能亢进的初始表现可能伴有严重的心脏症状。当人口统计学特征与常见的缺血性心脏病不符时，应调查其他可能的症状和体征，并检查甲状腺功能。控制甲状腺功能亢进将导致心脏和非心脏症状的缓解。
