The Abnormal Sinus Rhythm: Myxedema Coma Complicated by Subacute Cardiac Tamponade

Abstract #797119: Myxedema Coma Manifesting as Cardiac Tamponade and Respiratory Failure

Endocrine Practice ◽

10.1016/s1530-891x(20)39461-1 ◽

2020 ◽

Vol 26 ◽

pp. 247-248

Author(s):

Krithika Suresh

Keyword(s):

Respiratory Failure ◽

Cardiac Tamponade ◽

Myxedema Coma

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Cardiac Tamponade - A Hypothyroidism Associated Emergency: A Report of 2 Cases

Austin Journal of Clinical Case Reports ◽

10.26420/austinjclincaserep.2021.1194 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Tripathi S ◽

◽

Sharma JB ◽

Vijayvergia P ◽

Khichar S ◽

...

Keyword(s):

Emergency Department ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Young Female ◽

Medical Emergency ◽

Myxedema Coma ◽

First Case ◽

History Of ◽

Medical Emergencies ◽

Recurrent Pericardial Effusion

Pericardial effusion in commonly seen in-patient with hypothyroidism but effusion large enough to cause cardiac tamponade is not a common presenting feature whereas myxedema coma is a commonly defined medical emergency in-patient with hypothyroidism. We report 2 cases of hypothyroid associated medical emergencies. First case is a young female with history of recurrent pericardial effusion presenting to the emergency department with cardiac tamponade and later on diagnosed as having hypothyroidism. The second patient is a known case of hypothyroidism non-compliant to thyroid supplement and presented with lethargy, fatigue, decreased talking and breathlessness who was later diagnosed as having myxedema coma and impending cardiac tamponade. Both the patient required percutaneous pericardiocentesis and improved with medical management.

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Cardiac Tamponade Physiology Caused by Large Pleural Effusion as a Manifestation of Myxedema Coma

CHEST Journal ◽

10.1378/chest.2280207 ◽

2015 ◽

Vol 148 (4) ◽

pp. 256A

Author(s):

Monia Werlang ◽

Jose Valery ◽

Jose Diaz-Gomez

Keyword(s):

Pleural Effusion ◽

Cardiac Tamponade ◽

Myxedema Coma

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SAT-458 A Case of Cardiac Arrest Due to Hashimoto’s Thyroiditis Associated Cardiac Tamponade

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.549 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Petra Krutilova ◽

Sabah Patel ◽

Wasey Ali Yadullahi Mir ◽

Janice L Gilden ◽

Uzma N Syed

Keyword(s):

Cardiac Arrest ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Hashimoto’S Thyroiditis ◽

Low Voltage ◽

Pulseless Electrical Activity ◽

Ambient Air ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Myxedema Coma

Abstract Introduction: Myxedema coma is currently an uncommon medical emergency. We present a case of undiagnosed Hashimoto’s thyroiditis with myxedema coma and cardiac tamponade leading to cardiac arrest. Case Presentation: A 35 year-old man with no significant past medical history was brought to the emergency department after being found unresponsive. The patient was hypoglycemic (17 mg/dL), hypothermic (34°C), tachypneic (26/min), hypotensive (84/50 mmHg), and hypoxemic (90% on ambient air). Physical exam showed mild anasarca, jugular vein distention, clear lung sounds, and muffled heart sounds. Laboratory findings showed TSH 168.16 uIU/mL (0.45–5.33 uIU/mL), fT4 <0.25 ng/dL (0.58–1.64 ng/dL), fT3 1.33 pg/mL (2.5–3.9 pg/mL), cortisol 5.7 mcg/dL (3–16 mcg/dL). Chest x-ray demonstrated markedly enlarged, globular heart. ECG revealed sinus rhythm and low voltage of QRS complexes. Echocardiogram was significant for a very large pericardial effusion. Resuscitation was started with intravenous thyroxine and hydrocortisone, during which the patient was found to be in a cardiac arrest with pulseless electrical activity. CPR per ACLS protocol was initiated with return of spontaneous circulation. Clear fluid (2000 ml) was evacuated from the pericardial space. He was diagnosed with Hashimoto thyroiditis (thyroid peroxidase antibody level 355 IU/mL, normal <9 IU/mL). He recovered without neurological deficits and was discharged home with thyroid replacement therapy (levothyroxine 100 mcg). Discussion: Myxedema coma occurs as a complication of undiagnosed/untreated thyroid disease. It may be precipitated by an event such as infection, drug overdose, or myocardial infarction. The mainstay of treatment is T4 replacement along with supportive therapy, and glucocorticoids to counter possible underlying adrenal insufficiency. Massive pericardial effusion due to hypothyroidism, especially resulting in cardiac tamponade, is extremely rare. The incidence of pericardial effusion in patients with hypothyroidism has significantly decreased from 30–80% to 3–6%, due to early recognition of this common disorder. Our case highlights the importance of prompt recognition of hypothyroidism as a cause of cardiac tamponade, thus allowing rapid life-saving treatment. In patient populations with limited access to health care, it should be remembered that very late and potentially fatal complications of otherwise easily treatable conditions can occur. Awareness of this may help limit morbidity and mortality. References: Kabadi UM, Kumar SP. Pericardial effusion in primary hyperparathyroidism. Am Heart J. 1990; 120:1393.

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433: CARDIAC TAMPONADE ASSOCIATED WITH MYXEDEMA COMA

Critical Care Medicine ◽

10.1097/01.ccm.0000528451.52786.b2 ◽

2018 ◽

Vol 46 (1) ◽

pp. 200-200

Author(s):

Akira Kuriyama ◽

Seigo Urushidani

Keyword(s):

Cardiac Tamponade ◽

Myxedema Coma

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A CASE OF DOWN SYNDROME WITH MYXEDEMA COMA AND CARDIAC TAMPONADE

CHEST Journal ◽

10.1016/j.chest.2018.08.220 ◽

2018 ◽

Vol 154 (4) ◽

pp. 243A

Author(s):

AELIA FATIMA ◽

GHULAM MURTAZA ◽

ARYA NIKAMAL ◽

KHANSA AHMAD ◽

ESSAM MEKHAIEL

Keyword(s):

Down Syndrome ◽

Cardiac Tamponade ◽

Myxedema Coma

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“MISSED-EDEMA” COMA: A CASE OF CARDIAC TAMPONADE MASKED BY MYXEDEMA COMA

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)33505-3 ◽

2019 ◽

Vol 73 (9) ◽

pp. 2899

Author(s):

Ishan Kamat ◽

Farzad Soleimani ◽

Raymond Stainback

Keyword(s):

Cardiac Tamponade ◽

Myxedema Coma

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How effective is cryoablation in the treatment of atrial fibrillation?

European Heart Journal Supplements ◽

10.1093/eurheartj/suab089 ◽

2021 ◽

Vol 23 (Supplement_E) ◽

pp. E51-E54

Author(s):

Diego Penela ◽

Riccardo Cappato

Keyword(s):

Atrial Fibrillation ◽

Energy Source ◽

Pericardial Effusion ◽

Sinus Rhythm ◽

Cardiac Tamponade ◽

Pulmonary Vein ◽

Phrenic Nerve ◽

The Other ◽

Cryoballoon Ablation ◽

Baseline Characteristics

Abstract Pulmonary vein isolation is the standard for atrial fibrillation ablation. Although the most commonly applied energy source is radiofrequency (RF), cryoablation has rapidly evolved as a powerful one-shot tool, particularly after the introduction of the second-generation catheter, gaining widespread use in recent years. The efficacy in maintaining sinus rhythm after a first ablative procedure is ∼70–80%, and the randomization studies comparing cryoablation to RF have not been able to reveal significant differences up to now. Although different baseline characteristics may influence the efficacy of cryoablation, we are not yet able to distinguish which patients may benefit from a personalized choice of ablative source. Regarding safety, cryoballoon ablation appears to be associated with a lower rate of pericardial effusion and cardiac tamponade, mainly due to the lack of risk of overheating. The other side of the coin is a higher incidence of phrenic nerve damage, which occurs in 1–2% of procedures. In conclusion, we do not yet have definitive data to affirm the superiority of the RF technique over that of cryoablation. The choice of energy source currently depends on the availability of the centre and on the experience of the operator.

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