背景:心肌缺血可由多种原因引起,导致心肌氧气的供需不平衡。这种情况的一个潜在原因是由于过度刺激的甲状腺功能导致的心脏过度劳累。
方法:患者是一名36岁女性,表现为左侧胸痛,呼吸困难,心悸,和震颤。初步评估显示,甲状腺功能亢进引起的心肌缺血(高敏肌钙蛋白阳性)。心肌梗塞的治疗,以及抗甲状腺药物,改善了病人的病情,缓解了症状。冠状动脉造影显示无病理发现,和运动不足的左心室,在第一次超声心动图中观察到,已解决。病人出院,临床情况良好,在服用钙通道阻滞剂和逐渐减少卡比马唑4个月后,甲状腺功能恢复正常,她的症状完全消失了.
结论:无明显缺血性心脏病危险因素的患者,如非糖尿病患者,不吸烟者,以及患有急性冠脉综合征的年轻人,应评估心肌氧需求和供应之间不平衡的潜在背景原因。心悸的存在,减肥,震颤,失眠,和焦虑,伴随着缺血症状,应该让医生思考甲状腺功能亢进引起的心血管疾病的可能性。
■最初的甲状腺功能亢进可能伴有严重的心脏症状。当人口统计学特征与通常的缺血性心脏病不一致时,其他可能的症状和体征应进行调查,甲状腺功能应该检查。控制甲状腺功能亢进将导致心脏和非心脏症状的解决。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
UNASSIGNED: 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.