Abstract
### Case 1 A 79-year-old woman from Sri Lanka, with a history of hyperthyroidism, presented with chest pain and breathlessness following an episode of extreme anxiety after missing her connecting flight. She had been unable to take carbimazole during the preceding 3 months due to local shortages. Examination revealed signs of acute heart failure, with an electrocardiogram (ECG) showing anterior T-wave inversion, a 12-h cardiac Troponin I of 4.1 ng/ml and thyroid function tests demonstrating thyrotoxicosis (free thyroxine [fT4] 40.4 pmol/l, thyroid-stimulating hormone [TSH] 0.04 mU/l). Coronary angiography showed only minor disease in the left anterior descending and circumflex arteries. Ventriculography revealed classical apical ballooning and left ventricular dysfunction. Cardiovascular magnetic resonance (CMR) imaging on Day 3 confirmed this finding on cine imaging and without evidence of delayed gadolinium hyperenhancement (Figure 1). Her symptoms resolved within 4 …
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