Takotsubo cardiomyopathy in amiodarone-induced hyperthyroidism

Abstract

SummaryTakotsubo cardiomyopathy (TC) is an atypical, severe but reversible form of acute heart insufficiency. It typically presents with left ventricular failure, transient apical and mid-segments hypokinesis, absence of significant coronary stenosis and new electrographic abnormalities and/or elevation in serum cardiac enzymes. Although TC (‘broken heart syndrome’) has classically been associated with emotional trauma, evidence suggests that other precipitants might exist, including iatrogenic and thyroid-mediated forms. Thyroid disease is a relatively common comorbidity in TC patients. We report a case of TC in a postmenopausal female with no history of emotional trauma or other potential precipitant factors who was diagnosed with amiodarone-induced hyperthyroidism during her hospital stay. Though some case reports of thyroid-related TC exist, we are not aware of any other reported case of TC precipitated by amiodarone-induced hyperthyroidism.Learning points:TC is a relatively new, rare, transient, severe, but reversible cardiovascular condition that is characterized by an acute left ventricular cardiac failure, which can clinically, analytically and electrocardiographically mimic an acute myocardial infarction.Many precipitant factors have been described in TC, being the most classical and emotional trauma. However, thyroid dysfunction is also a significant condition frequently found in patients with TC.A hypercatecholaminergic state leading to cardiomyocyte damage has been established as the main fact of TC physiopathology. Hyperthyroidism induces an upregulation of β-adrenergic receptors.Both hyperthyroidism and hypothyroidism have been related with TC development. Most reported cases of TC involving thyroid dysfunction correspond to hyperthyroidism due to Graves–Basedow disease, but there are also descriptions with severe hypothyroidism, radioiodine treatment or thyroid surgery.Amiodarone is a class III antiarrhythmic agent widely used, and it is a well-known cause of thyroid dysfunction, which can present either with hypothyroidism or hyperthyroidism, as approximately 40 percent of the amiodarone molecule is composed of iodine.In this case, a type II amiodarone-induced hyperthyroidism was the precipitant factor of a TC in a patient with a pre-existing atrial fibrillation. Given the high prevalence of atrial fibrillation and the wide use of amiodarone, the risk of this iatrogenic effect should be taken into account.

Atypical Takotsubo Cardiomyopathy Precipitated by Gastrointestinal Bleeding: Review of the Pathophysiology

“…Various triggers have been reported including ischemic stroke [3], amiodarone-induced hyperthyroidism [5], and post-surgical procedures. Our patient presented with chest pain and electrocardiographic findings concerning for ST segment myocardial infarction.…”

Reverse Takotsubo Cardiomyopathy Following COVISHIELD Vaccination: A Rare Case of an Anaphylactic Reaction

“…Catecholamine surge is widely accepted as an underlying predominant factor with resultant myocardial stunning, multivessel coronary artery spasm, impaired fatty acid metabolism, and endothelial dysfunction [ 10 ]. A study of the literature shows that apart from emotional and psychological stress, there are several cases where external factors contribute to TTC, such as surgery, fracture, vaginal delivery, anti-cancer drugs, and amiodarone [ 13 ]. Exogenous catecholamine administration is also a well-recognized trigger.…”

The Thyroid Axis in Peripartum Cardiomyopathy: A Potential Contributor to a Multifaceted Disease

“…4 Early in the disease course, an increase in cardiac output is observed; however, long-term untreated hyperthyroidism causes excessive cardiac workload, leading to hypertrophy and high-output heart failure. Systolic heart failure has also been reported in numerous settings including stress cardiomyopathy, [5][6][7] possibly due to heightened sensitivity to catecholamines common to both conditions. Uninodular, multinodular, or diffuse goiter, as well as thyrotoxicosis, have been previously associated with a PPCM diagnosis in 1337 women in the United States, 8 supporting the association between hyperthyroidism and PPCM.…”