propylthiouracil and Coronary-Vasospasm

We describe a 47-year-old woman with severe coronary vasospasm induced by hyperthyroidism. The patient complained of anginal chest pain without specific characteristics of thyrotoxicosis. Coronary arteriography was performed and revealed 90% stenosis of both the left and right coronary os. She was treated with emergent coronary artery bypass graft surgery. Postoperatively, she exhibited a comatose mentality. Severe thyrotoxicosis was indicated on thyroid function tests and thyrotoxic storm was diagnosed. Nineteen days after the surgery and following the initiation of propylthiouracil treatment, coronary arteriography revealed entirely normal coronary arteries.

Topics: Angina, Unstable; Antithyroid Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vasospasm; Female; Humans; Middle Aged; Propylthiouracil; Thyroid Crisis; Thyroid Hormones; Thyrotoxicosis

While angina is not uncommonly seen in association with hyperthyroidism, only rare case reports have suggested that myocardial ischemia in this state may be due to coronary artery spasm. The authors review the literature and describe a case in which the repetitive occurrence of episodes of myocardial ischemia due to coronary spasm correlated with repeated transient elevations in thyroid hormone levels, thus clarifying this relationship. The importance of defining thyroid status in patients presenting with coronary vasospasm is emphasized and the effects of thyroid hormone on the heart are reviewed.

Topics: Coronary Vasospasm; Electrocardiography; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Middle Aged; Nitroglycerin; Propylthiouracil; Thyroxine; Triiodothyronine