Rare Case of Stress Cardiomyopathy After Thyroidectomy
Posted: Wednesday, March 10, 2021
Yuhong Chen, MD, of The Fourth Hospital of Hebei Medical University, Shijiazhuang, China, and colleagues presented a case of a 37-year-old woman hospitalized with a mass in her thyroid. After undergoing left thyroidectomy and lymph node dissection, the patient showed rare signs of stress cardiomyopathy, which often mimic acute myocardial infarction.
The patient had no risk factors or medical history of coronary heart disease, and all preoperative examinations appeared to be normal. After extubation, the patient began coughing up frothy, pink mucus and vomiting. Upon further examination, her blood pressure was 100/55 mmHg, pulse was 112 beats/minute. The crackling was heard during chest auscultation, and oxygen saturation was at 85% despite a high-flow oxygen mask; she was reintubated.
An electrocardiogram demonstrated ST-segment depression in leads II, III, aVF, and V1 to V5; chest x-ray showed ground-glass opacities in both lungs; and ultrasonic echocardiography revealed hypokinetic motion of the left mid-ventricular segment, with a left ventricular ejection fraction decrease to 36%. Troponin, myoglobin, and B-type natriuretic peptide levels were all elevated, but thyroid levels were within the normal range. A provisional diagnosis of stress cardiomyopathy was made, but the patient’s husband refused coronary angiography.
Deep sedation, anticoagulation, analgesia, cardioprotective drugs, levosimendan (a calcium sensitizer), antibiotics, low-dose norepinephrine, and other supportive therapy were administered. Bedside ultrasonography was used to evaluate cardiac function. Upon her troponin levels rising after 24 hours, CT angiography was performed yet revealed normal coronary arteries without significant stenosis.
There was a gradual improvement in the patient’s condition, and after 6 days of ventilation, she was extubated. Echocardiography demonstrated restoration of left ventricular ejection fraction to 60%, and cardiac magnetic resonance was performed 9 days after transfer to reveal normal ventricular function. About 3 weeks after surgery, the patient was discharged from the hospital without symptoms.
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