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. 2024 Sep 4;17(1):111.
doi: 10.1186/s12245-024-00695-1.

Unexpected Grave's-induced acute myocardial infarction in a young female, a literature review based on a case report

Fatemeh Naderi  1 , Narges Naderi  2 , Seyedeh Maryam Mousavinezhad  3 , Amin Zaki Zadeh  3
Affiliations

Unexpected Grave's-induced acute myocardial infarction in a young female, a literature review based on a case report

Fatemeh Naderi et al. Int J Emerg Med. .

Abstract

Introduction: Myocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the heart due to hyperstimulated thyroid function.

Case presentation: The patient was a 36-year-old woman who presented with left-sided chest pain, dyspnea, palpitation, and tremor. The initial evaluation showed evidence of myocardial ischemia (positive high-sensitivity troponin) caused by a hyperactive thyroid gland. The treatment for myocardial infarction, along with anti-thyroid medications, improved the patient's condition and subsided the symptoms. The coronary angiography revealed no pathologic finding, and the hypokinetic left ventricle, observed in the first echocardiogram, was resolved. The patient was discharged with an excellent clinical condition, and after the 4-month taking of a calcium channel blocker and tapering carbimazole, the thyroid function became normal, and her symptoms resolved completely.

Conclusion: Patients without evident risk factors for ischemic heart disease, such as non-diabetic, nonsmoker, and young individuals who presented with acute coronary syndrome, should be evaluated for a potential background reason for the imbalance between the oxygen demand and supply of the myocardium. The presence of palpitation, weight loss, tremors, insomnia, and anxiousness, along with ischemic signs, should make the physician think about the probability of the hyperthyroid-induced cardiovascular disorder.

Clinical key point: The initial presentation of hyperthyroidism might be accompanied by severe cardiac symptoms. When the demographic features are not aligned with usual ischemic heart disease, other probable symptoms and signs should be investigated, and thyroid function should be checked. The control of thyroid hyperactivity would result in the resolution of both cardiac and non-cardiac symptoms.

Keywords: Acute coronary syndrome; Case report; Hyperthyroidism; Interventional cardiology; Myocardial ischemia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The initial electrocardiogram showed sinus tachycardia without any other remarkable finding
Fig. 2
Fig. 2
The 4th electrocardiogram, performed 90 min after the initial electrocardiogram, showed dynamic changes in limbs (blue arrows) and precordial (red arrows) leads
Fig. 3
Fig. 3
The coronary angiography of the patient showed no abnormal finding
Fig. 4
Fig. 4
Resolution of tachycardia and ST-segment changes in the follow-up ECGs
See this image and copyright information in PMC

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