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Chronic thyrotoxic myocarditis complicated by myocardial rupture in a patient with autoimmune thyroiditis

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Abstract


A case of thyrotoxic myocarditis in a 60-year-old female patient is oresented. With the diagnosis of «Unstable angina» she was admitted to the intensive care unit for patients with myocardial infarction at the Yudin city clinical hospital in Moscow. Earlier, the patient had been treated with tyrosol for thyrotoxicosis, but she independently abolished the drug. She ecperienced pain in the chest for the first time in her life. Emergency, coronaroangiography was performed. No hemodynamically significant damage to the blood vessels of the heart was detected. Later, according to the outpatient blood test for thyroid hormones, a diagnosis was established — «severe thyrotoxicosis». The next day after hospitalization, treatment with tyrosol was started at a dose of 30 mg per day. Sinus tachycardia persisted. A reliable increase in cardiospecific enzymes was detected. The pain in the chest did not recur. Echocardiography did not reveal impairment of local or global myocardial contractility.

On the fifth day of hospital treatment the patient suddenly died of cardiac and respiratory arrest.

The autopsy study revealed autoimmune thyroiditis, thyrotoxic serous-lymphocytic myocarditis, which was complicated by a rupture of the myocardium, and pericardial gemotamponade.

The difficulties of differential diagnosis of myocarditis and acute coronary syndrome and the features of treatment tactics in elderly patients with thyrotoxicosis are discussed.


Natalya A. Cherkasova

I.M. Sechenov First Moscow State Medical University (Sechenov University); S.S. Yudin Moscow City Clinical Hospital

Author for correspondence.
Email: cherkasova31@gmail.com
ORCID iD: 0000-0001-8483-4982
SPIN-code: 8788-3155

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992; 4, Kolomenskiy driveway, Moscow, 115446

MD, PhD

Georgy O. Zairatyants

I.M. Sechenov First Moscow State Medical University (Sechenov University); S.S. Yudin Moscow City Clinical Hospital

Email: goshaz@mail.ru
ORCID iD: 0000-0002-9265-5017
SPIN-code: 9451-8903

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992; 4, Kolomenskiy driveway, Moscow, 115446

MD, PhD

Natalya A. Ananitcheva

I.M. Sechenov First Moscow State Medical University (Sechenov University); S.S. Yudin Moscow City Clinical Hospital

Email: n.ananicheva@mail.ru
ORCID iD: 0000-0002-3142-619X
SPIN-code: 2247-0561

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992; 4, Kolomenskiy driveway, Moscow, 115446

MD

Svetlana E. Kolendo

I.M. Sechenov First Moscow State Medical University (Sechenov University); S.S. Yudin Moscow City Clinical Hospital

Email: telets.28.piter@mail.ru
ORCID iD: 0000-0002-1368-1605
SPIN-code: 7021-3827

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992; 4, Kolomenskiy driveway, Moscow, 115446

MD, PhD

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Supplementary files

Supplementary Files Action
1. Fig. 1. The results of the patient's electrocardiogram N., performed by the emergency medical service. View (609KB) Indexing metadata
2. Fig. 2. ECG of the patient N. from 17.02.17 in dynamics. View (606KB) Indexing metadata
3. Fig. 3. ECG of the patient N. from 20.02.17 while receiving tyrosol. View (386KB) Indexing metadata
4. Fig. 4. Macrodrug of the heart. The zone of myocardial necrosis (yellow-green), with a gap, the walls of the gap are infiltrated with blood. View (894KB) Indexing metadata
5. Fig. 5. Microdrug of the heart. In the area of necrosis, marked infiltration with segmented leukocytes. Stained with hematoxylin and eosin (× 100). View (1MB) Indexing metadata
6. Fig. 6. Microdrug myocardium. Picture of serous-lymphocytic myocarditis with diffuse infiltration of lymphocytes, muscle fiber necrosis, pronounced interstitial edema. Stained with hematoxylin and eosin (× 400). View (1MB) Indexing metadata
7. Fig. 7. Macrodrug of the thyroid gland with a picture of the hypertrophic phase of autoimmune thyroiditis. View (1MB) Indexing metadata
8. Fig. 8. Microdrug of a thyroid gland. Diffuse-focal lymphocytic infiltration mixed with plasma cells, destruction of thyrocytes, follicular hyperplasia, focal sclerosis of the stroma of the gland. Stained with hematoxylin and eosin (× 400). View (1MB) Indexing metadata

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Copyright (c) 2019 Cherkasova N.A., Zairatyants G.O., Ananitcheva N.A., Kolendo S.E.

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