J Korean Soc Endocrinol.  2006 Jun;21(3):233-238. 10.3803/jkes.2006.21.3.233.

A Case of Hyperthyroidism with Complete Atrioventricular Block and Cardiac Arrest

• Lee HS
• Yang YS
• Jo IG
• Jang SI
• Jung SC

• KMID: 2200735
• DOI: http://doi.org/10.3803/jkes.2006.21.3.233

Abstract

The cardiovascular manifestations of hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular block, bundle branch block, angina pectoris, heart failure, and cardiomyopathy. Though complete atrioventricular block is rare, it is important to recognize it in clinical practice because of the possibility of cardiac arrest. We experienced a 47-year-old female patient who had hyperthyroidism with complete atrioventricular block and developed cardiac arrest despite the initiation of an antithyroid drug. We could resuscitate successfully and inserted a temporary pacemaker, but eventually a permanent pacemaker was needed to prevent the recurrence of cardiac arrest. We report a rare case of complete atrioventricular block and cardiac arrest associated with hyperthyroidism with the review of references.

MeSH Terms

Angina Pectoris
Atrial Fibrillation
Atrial Flutter
Atrioventricular Block*
Bundle-Branch Block
Cardiomyopathies
Female
Heart Arrest*
Heart Failure
Humans
Hyperthyroidism*
Middle Aged
Recurrence
Tachycardia, Sinus
Tachycardia, Supraventricular

Figure

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  Fig. 1 Routine electrocardiography on the day of admission. Complete atrioventricular block with ventricular premature contractions can be noted.

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  Fig. 2 Electrocardiography on the time of cardiopulmonary resuscitation after cardiac arrest. Ventricular fibrillation and accelerated idioventricular rhythms were noted.

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  Fig. 3 Electrocardiography after insertion of temporary pacemaker.

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  Fig. 4 Electrocardiography after removal of the temporary pacemaker.

Reference

1. Lee MH, Lee E, Kim YL, Shong YK, Kim YH, Ahn IM. A case of ventricular fibrillation associated with hyperthyroidism. J Kor Soc Endocrinol. 1998. 13:459–465.

2. Lee J, Lee CB, Park YS, Kim DS, Choi WH, Kim TW, Ahn YH. A case of hyperthyroidism with complete atrioventricular block. Korean J Med. 2005. 68:220–225.

3. Topaloglu S, Topaloglu OY, Ozdemir O, Soylu M, Demir AD, Korkmaz S. Hyperthyroidism and complete atrioventricular block a report of 2 cases with electrophysiologic assessment. Angiology. 2005. 56:217–220.

4. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Williams textbook of endocrinology. 2003. 10th ed. Philadelphia: W.B. Saunders;374.

5. Eraker SA, Wickamasekaran R, Goldman S. Complete heart block with hyperthyroidism. JAMA. 1978. 239:1644–1646.

6. Polikar R, Kennedy B, Ziegler M, O'Connor DT, Smith J, Nicod P. Plasma norepinephrine kinetics, dopamine B-hydroxylase, and chromogranine-a in hypothyroid patients before and following replacement therapy. J clin Endocrinol Metab. 1990. 70:277–281.

7. Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Am J Med. 1990. 88:631–637.

8. Osman F, Ayuk J, Dale J, Franklyn JA, Gammage MD. Thyrotoxicosis with heart block. J R Soc Med. 2001. 94:346–348.

9. Chen YC, Chen SA, Chen YJ, Chang MS, Chan P, Lin CI. Effects of thyroid hormone on the arrhythmogenic activity of pulmonary vein cardiomyocytes. J Am Coll Cardiol. 2002. 39:366–372.

10. Ortmann C, Pfeiffer H, Du Chesne A, Brinkmann B. Inflammation of the cardiac conduction system in a case of hyperthyroidism. Int J Legal Med. 1999. 112:271–274.

11. Davis AC, Smith HL. Complete heart block in hyperthyroidism following acute infections: A report of 6cases with necropsy findings in 1 case. Am heart J. 1933. 9:81–89.

12. Muggia AL, Stjernholm M, Houle T. Complete heart block with thyrotoxic myocarditis: report of case. N Engl J Med. 1970. 283:1099–1100.

13. Shirani J, Barron MM, Pierre-Louis ML, Roberts WC. Congestive heart failure, dilated cardiac ventricles, and sudden death in hyperthyroidism. Am J Cardiol. 1993. 72:365–368.

14. Zipes DP, Libby P, Bonow RO, Braunwald E. A textbook of cardiovascular medicine. 2005. 7th ed. Philadelphia: W.B. Saunders;858.

15. Buyon JP, Ben-Chetri E, Karp S, Roubey RA, Pompeo L, Reeve WH, Tan EM, Winchester R. Acquired congenital heart block: pattern of maternal antibody response to biochemically defined antigens of the SSA/Ro-SSB/La system in neonatal lupus. J Clin Invest. 1989. 84:627–634.

16. Nakazawa HK, Hamada N, Momotani N, Ito K. Management of atrial fibrillation in the post-thyrotoxicosis state. Am J Med. 1982. 72:903–906.