Tachycardiomyopathy Due To Hyperthyroidism: Case Report

Abstract

Introduction High output heart failure (HF) is one of the complications of hyperthyroidism. Some patients may evolve with reduced ejection fraction HF (HFREF) due to tachycardiomyopathy. The most prevalent arrhythmias are atrial fibrillation and atrial flutter, which, when controlled, improve HF. Hypotheses: Tachycardiomyopathy resulting from hyperthyroidism. Methods Descriptive, qualitative, and documentary study of the “case report” type. Case report Male, 35 years old, with no previous comorbidities, sought emergency with signs of decompensated HF associated with palpitations, hyperthermia, sweating, anterior neck pain, and extremity tremors. Thyroid with increased volume resulting from multiple nodules, without murmurs; bilateral exophthalmos; propulsive ictus with two digital pulps, in the sixth left intercostal space, irregular heart rhythm, HR 140bpm, pathological jugular venous pressure, bilateral crackles up to middle third. Lower limbs with edema + 3 / + 4. EKG in high-response atrial fibrillation rhythm reversed during hospitalization with amiodarone. ECHO with severe global LV systolic dysfunction with Simpson's ejection fraction 12%. He was discharged from the hospital with carvedilol, furosemide, amiodarone, and oral anticoagulant, being referred to primary care. Doppler ultrasonography of the thyroid showing increased volume, lobulated contours with diffuse heterogeneous parenchyma of multinodular aspect, and increased vascularity. Laboratory tests confirmed hyperthyroidism (TSH 0.008 mU / L; T4L 2.22 ng / dL; TRAB 9.58 IU / L). Optimized treatment for HF (added enalapril and spironolactone), it evolved in NYHA I, with a new ECHO after 3 months showing mild LV dysfunction with 45% EF. In a joint follow-up with endocrinology, under treatment with Methimazole, awaiting thyroidectomy. Conclusion Hyperthyroidism increases metabolic demand and can lead to cardiovascular complications such as HF and atrial arrhythmias. This occurs by increasing blood volume, reducing systemic vascular resistance and reducing circulation time, triggering LV hypertrophy, and reducing myocardial contractile reserve. The hyperthyroidism with decompensated HF is a medical emergency with up to 30% mortality. It is a treatable entity, and its complications are potentially reversible. High output heart failure (HF) is one of the complications of hyperthyroidism. Some patients may evolve with reduced ejection fraction HF (HFREF) due to tachycardiomyopathy. The most prevalent arrhythmias are atrial fibrillation and atrial flutter, which, when controlled, improve HF. Hypotheses: Tachycardiomyopathy resulting from hyperthyroidism. Descriptive, qualitative, and documentary study of the “case report” type. Male, 35 years old, with no previous comorbidities, sought emergency with signs of decompensated HF associated with palpitations, hyperthermia, sweating, anterior neck pain, and extremity tremors. Thyroid with increased volume resulting from multiple nodules, without murmurs; bilateral exophthalmos; propulsive ictus with two digital pulps, in the sixth left intercostal space, irregular heart rhythm, HR 140bpm, pathological jugular venous pressure, bilateral crackles up to middle third. Lower limbs with edema + 3 / + 4. EKG in high-response atrial fibrillation rhythm reversed during hospitalization with amiodarone. ECHO with severe global LV systolic dysfunction with Simpson's ejection fraction 12%. He was discharged from the hospital with carvedilol, furosemide, amiodarone, and oral anticoagulant, being referred to primary care. Doppler ultrasonography of the thyroid showing increased volume, lobulated contours with diffuse heterogeneous parenchyma of multinodular aspect, and increased vascularity. Laboratory tests confirmed hyperthyroidism (TSH 0.008 mU / L; T4L 2.22 ng / dL; TRAB 9.58 IU / L). Optimized treatment for HF (added enalapril and spironolactone), it evolved in NYHA I, with a new ECHO after 3 months showing mild LV dysfunction with 45% EF. In a joint follow-up with endocrinology, under treatment with Methimazole, awaiting thyroidectomy. Hyperthyroidism increases metabolic demand and can lead to cardiovascular complications such as HF and atrial arrhythmias. This occurs by increasing blood volume, reducing systemic vascular resistance and reducing circulation time, triggering LV hypertrophy, and reducing myocardial contractile reserve. The hyperthyroidism with decompensated HF is a medical emergency with up to 30% mortality. It is a treatable entity, and its complications are potentially reversible.