Mathew Tobin, Tang Kevin S, Gul Fahad, Sandhu Sareen, Vadpey Omid, Yang Qin, Donaldson David
University of California, Irvine Medical Center, Department of Medicine, Division of Cardiology, Orange, CA, USA.
University of California, Irvine Medical Center, Department of Medicine, Division of Endocrinology, Orange, CA, USA.
J Cardiol Cases. 2025 Jan 30;31(4):113-116. doi: 10.1016/j.jccase.2025.01.002. eCollection 2025 Apr.
Ventricular fibrillation (VF) is an often-fatal cardiac arrhythmia with increased prevalence in those with structural heart disease, congestive heart failure, and history of myocardial infarction. Our case describes a young adult male who presented with VF arrest and new onset cardiomyopathy in the setting of exogenous testosterone and triiodothyronine supplementation. Comprehensive work-up demonstrated a severely reduced ejection fraction, no angiographically significant coronary artery disease on invasive coronary angiography, and evidence of right ventricular mid-lateral wall scarring on electrophysiology study and cardiac magnetic resonance imaging. Exogenous thyroid hormone and testosterone supplementation have been independently associated with development of dilated cardiomyopathy; however, VF arrest has rarely been described in otherwise previously healthy individuals with concomitant use of these substances. Optimal management, risk stratification, and prognosis in this population remains unknown. Our case identifies an at-risk population of sudden cardiac death where appropriate work-up and shared clinical decision-making is essential to improved patient outcomes and quality of life.
Exogenous triiodothyronine (T3) intake may be a risk factor for the development of acute cardiomyopathy, as cardiac myocytes directly uptake T3 which can induce arrhythmias and cardiac arrest. This process may be separate from tachycardia-mediated cardiomyopathy. Prognosis of hyperthyroid induced ventricular fibrillation and cardiomyopathy is unclear. Reversing the hyperthyroid state may reduce the risk of repeat sudden cardiac death. The decision for secondary prevention should be a joint decision understanding patient-specific risk factors and goals.
室颤（VF）是一种常致命的心律失常，在患有结构性心脏病、充血性心力衰竭和心肌梗死病史的人群中患病率增加。我们的病例描述了一名年轻成年男性，他在补充外源性睾酮和三碘甲状腺原氨酸的情况下出现室颤骤停和新发心肌病。全面检查显示射血分数严重降低，侵入性冠状动脉造影未发现有血管造影意义的冠状动脉疾病，电生理研究和心脏磁共振成像显示右心室中外侧壁有瘢痕形成。外源性甲状腺激素和睾酮补充剂已分别与扩张型心肌病的发生有关；然而，在同时使用这些物质的原本健康个体中，很少有室颤骤停的描述。该人群的最佳管理、风险分层和预后仍不清楚。我们的病例确定了一个心脏性猝死的高危人群，在此人群中，适当的检查和共同的临床决策对于改善患者预后和生活质量至关重要。
外源性三碘甲状腺原氨酸（T3）摄入可能是急性心肌病发生的一个危险因素，因为心肌细胞直接摄取T3，这可诱发心律失常和心脏骤停。这个过程可能与心动过速介导的心肌病不同。甲状腺功能亢进诱发的室颤和心肌病的预后尚不清楚。逆转甲状腺功能亢进状态可能会降低再次心脏性猝死的风险。二级预防的决策应该是一个综合考虑患者特定风险因素和目标的共同决策。
