Myocardial Infarction Associated with Coronary Angiography

Granett, Jeffrey R.; Mandel, Gilbert B.; Solomon, Norman; Bobroff, Lewis M.; Scheuer, James

doi:10.1378/chest.65.6.680

Cited by 5 publications

(1 citation statement)

References 6 publications

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“…Mechanisms involved in temporary coronary arterial occlu¬ sion include arterial spasm ( 11 ) or arterial thromboembolism with recanalization of the lumen (12). In variant angina, arterial spasm has been documented without concomitant significant atheromatous coronary artery disease (13), but the patient's history was negative in this regard and no spasm was induced with ergonovine.…”

Section: Discussionmentioning

confidence: 99%

Factitious Hyperthyroidism Causing Acute Myocardial Infarction

Locker¹,

Kotzmann²,

Frey³

et al. 1995

Thyroid

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Myocardial ischemia is a rare but severe and possibly life threatening manifestation of hyperthyroidism, but does not usually result in persistent ischemia. We report on a 71-year-old woman who had undergone total thyroidectomy with subsequent irradiation because of follicular carcinoma 3 years ago. Since then, she had been maintained on oral levothyroxine replacement therapy at a dose of 0.15 mg alternating with 0.2 mg daily. When latent hypothyroidism became evident despite replacement therapy, the dose of levothyroxine was increased to 0.3 mg a day. Three weeks later, the patient suffered from an acute posterior myocardial infarction, although she had no previous history of coronary artery disease. Subsequent coronary arteriograms revealed no evidence of disease of the major vessels. Myocardial scintigraphy 3 weeks after infarction still revealed a persistent perfusion defect. Since it is known that thyroid hormones increase oxygen demand, the rapid elevation of oxygen utilization caused by thyrotoxicosis factitia is likely to be responsible for this patient's myocardial infarction. The case illustrates that a sudden increase in levothyroxine replacement dose should be avoided.

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Section: Discussionmentioning

confidence: 99%