Abstract
A 38-year-old black woman with thyrotoxicosis, whose first symptom was angina pectoris, is described. Chest pain became progressively more frequent, and an unstable angina pattern developed. Angina attacks were associated with transient ischemic electrocardiographic changes and recurrent ventricular tachycardia was documented. Coronary angiography revealed no significant obstructive lesions. The patient became free of pain with antithyroid treatment and angina has not recurred.
It is important to recognize that angina pectoris may be the major presenting symptom of thyrotoxicosis; unstable angina requires careful work-up and management including the performance of coronary angiography.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BURSTEIN J., LAMBERG B. A., ERAMAA E. Myocardial infarction in thyrotoxicosis. Acta Med Scand. 1960 Apr 20;166:379–393. doi: 10.1111/j.0954-6820.1960.tb17392.x. [DOI] [PubMed] [Google Scholar]
- Buccino R. A., Spann J. F., Jr, Pool P. E., Sonnenblick E. H., Braunwald E. Influence of the thyroid state on the intrinsic contractile properties and energy stores of the myocardium. J Clin Invest. 1967 Oct;46(10):1669–1682. doi: 10.1172/JCI105658. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cheah J. S., Lee G. S., Chew L. S. Myocardial infarction in thyrotoxicosis. Med J Aust. 1971 Feb 13;1(7):393–395. doi: 10.5694/j.1326-5377.1971.tb87594.x. [DOI] [PubMed] [Google Scholar]
- DeGroot W. J. Cardiomyopathy associated with endocrine disorders. Cardiovasc Clin. 1972;4(1):305–331. [PubMed] [Google Scholar]
- DeGroot W. J., Leonard J. J. Hyperthyroidism as a high cardiac output state. Am Heart J. 1970 Feb;79(2):265–275. doi: 10.1016/0002-8703(70)90318-2. [DOI] [PubMed] [Google Scholar]
- GRISWOLD D., KEATING J. H., Jr Cardiac dysfunction in hyperthyroidism; a study of 810 cases. Am Heart J. 1949 Dec;38(6):813–822. doi: 10.1016/0002-8703(49)90883-2. [DOI] [PubMed] [Google Scholar]
- HOFFMAN I., LOWREY R. D. The electrocardiogram in thyrotoxicosis. Am J Cardiol. 1960 Nov;6:893–904. doi: 10.1016/0002-9149(60)90289-7. [DOI] [PubMed] [Google Scholar]
- Lopes M. G., Harrison D. C., Schroeder J. S. Ventricular arrhythmias during unstable angina pectoris. Arch Intern Med. 1975 Dec;135(12):1548–1553. [PubMed] [Google Scholar]
- ROWE G. G., HUSTON J. H., WEINSTEIN A. B., TUCHMAN H., BROWN J. F., CRUMPTON C. W. The hemodynamics of thyrotoxicosis in man with special reference to coronary blood flow and myocardial oxygen metabolism. J Clin Invest. 1956 Mar;35(3):272–276. doi: 10.1172/JCI103273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Resnekov L., Falicov R. E. Thyrotoxicosis and lactate-producing angina pectoris with normal coronary arteries. Br Heart J. 1977 Oct;39(10):1051–1057. doi: 10.1136/hrt.39.10.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SANDLER G., WILSON G. M. The production of cardiac hypertrophy by thyroxine in the rat. Q J Exp Physiol Cogn Med Sci. 1959 Jul;44:282–289. doi: 10.1113/expphysiol.1959.sp001401. [DOI] [PubMed] [Google Scholar]
- Sonnenblick E. H., Ross J., Jr, Braunwald E. Oxygen consumption of the heart. Newer concepts of its multifactoral determination. Am J Cardiol. 1968 Sep;22(3):328–336. doi: 10.1016/0002-9149(68)90117-3. [DOI] [PubMed] [Google Scholar]
- Theilen E. O., Wilson W. R. Hemodynamic effects of peripheral vasoconstriction in normal and thyrotoxic subjects. J Appl Physiol. 1967 Feb;22(2):207–210. doi: 10.1152/jappl.1967.22.2.207. [DOI] [PubMed] [Google Scholar]
- WILSON W. R., THEILEN E. O., FLETCHER F. W. PHARMACODYNAMIC EFFECTS OF BETA-ADRENERGIC RECEPTOR BLOCKADE IN PATIENTS WITH HYPERTHYROIDISM. J Clin Invest. 1964 Aug;43:1697–1703. doi: 10.1172/JCI105045. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wei J. Y., Genecin A., Greene H. L., Achuff S. C. Coronary spasm with ventricular fibrillation during thyrotoxicosis: response to attaining euthyroid state. Am J Cardiol. 1979 Feb;43(2):335–339. doi: 10.1016/s0002-9149(79)80023-5. [DOI] [PubMed] [Google Scholar]