STEMI and Thyroid Storm: A Case Report of Thyrotoxicosis-Induced Cardiomyopathy

Abstract

Thyrotoxicosis-induced cardiomyopathy is a rare but potentially fatal form of non-ischemic cardiomyopathy that warrants immediate medical intervention. A 51-year-old female with no known disease sought consultation because of severe chest pain accompanied by easy fatigability and palpitation. Upon arrival at the ED, there was persistence of chest pain accompanied by vomiting, tachycardia and hypotension. ECG showed STEMI in the lead aVR, and she eventually underwent coronary angiogram, which revealed normal coronary arteries. Ancillaries showed severe hyperthyroidism with a Burch – Wartofsky score of 50. There was an elevated NT-proBNP level, and echocardiogram showed a reduced EF of 28.7% with dilated LV and global hypokinesia. She was hooked to a norepinephrine and dobutamine drip and immediately initiated a hyperthyroid regimen, specifically methimazole, propranolol, and steroids. She was admitted to the critical care unit where initiation of SGLT-2 inhibitor and spironolactone were administered as part of the heart failure regimen. When she was out of thyroid storm, a sestamibi myocardial perfusion scan was requested, which showed normal results with improved EF. The goals of management in thyrotoxicosis-induced cardiomyopathy are early initiation of heart failure regimen, medication to prevent further ventricular remodeling, and treatment of thyroid storm. Early recognition and prompt administration of hyperthyroid treatment leads to a decreased burden of the patient’s disease and a good overall prognosis.