Thyrotoxicosis Mimicking ST Elevation Myocardial Infarction

Abstract

Hyperthyroidism is well known to be associated with cardiac disease. Delay in making the diagnosis and occurrence of complications are common and are associated with a worse outcome. A 54-year-old male, non-smoker, with no past medical history and no significant family history presented to our hospital with severe left sided chest pain, "crushing" in nature. Electrocardiogram showed ST-segment elevations in the inferior leads. Troponin I level was 0.32 ng/mL (normal range 0-0.05 ng/mL) on presentation. The patient underwent an emergent coronary angiography which showed no evidence of occlusive coronary artery disease. The patient's symptoms and signs prompted a high suspicion of thyrotoxicosis which was subsequently confirmed by a low thyroid stimulating hormone and high free thyroxine levels. The patient was given Methimazole and atenolol and his symptoms resolved. Awareness of coronary vasospasm due to thyrotoxicosis should be raised in patients presenting with typical angina pectoris with subsequent normal coronary angiographic results. History and physical examination may suggest underlying hyperthyroidism, but the absence of typical findings does not rule out the diagnosis.

Keywords: coronary angiography; hyperthyroidism; myocardial infarction; st elevation.

Figure 1. Electrocardiogram showing ST segment elevation in leads II, III and a ventricular fibrillation (VF)

Figure 2. Coronary angiography showing no obstruction

White arrow points to the left main coronary artery (CA). Black arrow points to the left anterior descending CA. Arrowhead points to the circumflex branch of the left CA

Figure 3. Coronary angiography showing no obstruction

Arrow points to the right coronary artery