methimazole and Takotsubo-Cardiomyopathy

Graves hyperthyroidism is commonly seen in clinical practice and Takotsubo stress cardiomyopathy is an increasingly recognized cardiac complication of physical or emotional stress. We report the rare case of a patient with Graves hyperthyroidism that was complicated by severe biventricular takotsubo cardiomyopathy, which was demonstrated on heart catheterization. After appropriate pharmacologic treatment of her hyperthyroidism, she had complete resolution of her cardiomyopathy.

Topics: Adult; Carbazoles; Carvedilol; Drug Therapy, Combination; Electrocardiography; Female; Graves Disease; Humans; Hyperthyroidism; Lisinopril; Methimazole; Propanolamines; Takotsubo Cardiomyopathy; Thyroid Function Tests; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right

A 55-years-old woman, with a history of hypertension and ischemic stroke with residual left hemiparesis, was admitted to our hospital because of dyspnoea with clinical evidence of acute pulmonary edema. She was found to have a sinus tachycardia with ST-elevation in leads D1, aVL and V1-V4 in the electrocardiogram, and akinesis of the left ventricular apex with overall left ventricular systolic function being severely impaired and an ejection fraction of 28% on echocardiography. Orotracheal intubation was performed and mechanical ventilation was immediately started. Emergency cardiac catheterization was performed 2 h after the symptom onset. Coronary angiography showed no significant coronary artery disease. Blood analysis revealed an increase in the creatine kinase MB fraction, a significant positive detection in troponin T, a white blood cell count of 35000 per microliter, C-reactive protein of 59,9 mg/dl, and transient elevation in the concentration of free triiodothyronine, free thyroxine, thyroid globulin antibody, and thyroid peroxidase antibody. The symptoms improved during the next days, and follow-up echocardiography 18 days later showed complete resolution of the left ventricular dysfunction. These data suggest that tako-tsubo cardiomyopathy may be induced in patients with sepsis and transient hyperthyroidism.

Topics: Amlodipine; Anti-Bacterial Agents; Antihypertensive Agents; Antithyroid Agents; Aspirin; Echocardiography; Electrocardiography; Female; Glucocorticoids; Humans; Hyperthyroidism; Methimazole; Middle Aged; Ofloxacin; Platelet Aggregation Inhibitors; Prednisone; Propranolol; Ramipril; Sepsis; Takotsubo Cardiomyopathy