Abstract
The management of hypothyroid patients for coronary artery bypass grafting (CABG) surgery has remained challenging. The patient will have depressed cardiac function with unpredictable response to the routine inotropes, depressed adrenergic response and baroreceptor reflexes, as well as increased systemic vascular resistance (SVR).Though there have been reports about the successful management of such patients, the risk is definitely higher. We hereby describe how we managed a grossly hypothyroid patient with unstable angina, using Levosimendan as the first choice inotrope.
Highlights
The management of hypothyroid patients before coronary artery bypass grafting (CABG) is very challenging
We report a case of iatrogenic hypothyroidism with unstable angina, where treating physicians were worried about triggering coronary event preoperatively by thyroid supplementation to correct the thyroid status
Among many cardiovascular abnormalities described in hypothyroid patients is impaired cardiac contractility with decreased cardiac output and increased peripheral vascular resistance
Summary
The management of hypothyroid patients before CABG is very challenging. Important consideration in hypothyroid patients for surgery include, increased sensitivity to depressant drugs, hypodynamic cardiovascular system with reduced heart rate (HR) & Cardiac Output (CO), slow metabolism of drugs, impaired ventillatory response, hypothermia, unresponsive baroreceptor reflex, primary adrenal insufficiency, decreased number and sensitivity of β receptors. Preoperative thyroid hormone therapy may precipitate angina in patients with ischemic heart disease and may contribute to myocardial infarction, this seems to be an infrequent event.[1] there have been few reports of incidences of heart failure in hypothyroid patients undergoing cardiac surgery.[2] On the contrary, some of the studies indicate that untreated hypothyroid patients tolerate cardiac surgery with few significant perioperative complications, rendering aggressive preoperative thyroid hormone replacement unnecessary Many of these studies and case reports of CABG in hypothyroid patients are usually on patients with mild to moderate hypothyroidism.[3]. We had to contemplate with managing a grossly hypopthyroid patient with unstable angina, as well as deal with stress induced thyroid crisis in this patient
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