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Case Reports: Learning from unexpected outcome (positive or negative)
Impending myocardial ischaemia during thyroid storm diagnosed through Wellens’ syndrome
  1. Shinjan Patra1,
  2. Anupriya Kaliyappan1,
  3. Atul Kaushik2 and
  4. Ayan Roy1
  1. 1Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  2. 2Cardiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India
  1. Correspondence to Dr Ayan Roy; drayanroy9{at}gmail.com

Abstract

We present a case of thyroid storm precipitated by discontinuation of antithyroid drugs. The patient developed a concurrent acute coronary event during the resolution period of the thyroid storm. After 48 hours of prudent management of thyroid storm, the patient’s sensorium and haemodynamics were stabilised but he had persistent mild chest discomfort and developed new-onset jaw pain. On admission, ECG showed sinus tachycardia. In consideration of persistent mild chest discomfort and new-onset jaw pain, serial ECGs were performed which revealed biphasic T waves in V2–V3 suggestive of Wellens’ syndrome type A. This indicated a critical stenosis of the left anterior descending (LAD) coronary artery and impending myocardial ischaemia. The patient underwent urgent coronary catheterisation, which revealed 80% stenosis of proximal LAD and was subsequently revascularised resolving his symptoms. This case underscores the significance of serial ECG monitoring even after the acute phase of thyroid crisis, which helped in timely identification of Wellens’ syndrome.

  • Thyrotoxicosis
  • Ischaemic heart disease

http://dx.doi.org/10.1136/bcr-2022-250488

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    Footnotes

    • Twitter @shinjan100

    • Contributors SP and AK acquired the data and SP drafted the report.AR and AtK revised and edited the report with critical inputs. AR, SP, AK and AtK were involved in the patient care.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.