ABSTRACT
The following case involves a 62-year-old female patient suffering from heart failure with reduced ejection fraction (HFrEF) secondary to non-ischemic cardiomyopathy and Graves disease, who developed ventricular fibrillation (VF) after discontinuation of methimazole in preparation for radioiodine ablation. Electrocardiogram (ECG) showed a severely prolonged QTc in the setting of thyrotoxicosis, which significantly improved with high dose methimazole. VF secondary to thyrotoxicosis has rarely been reported and the literature review shows scarce data on its mechanism. Our case demonstrates not only a possible mechanism for the arrhythmia, but also highlights a potential risk factor for it. The report details how discontinuing antithyroid medication leads to VF in our patient and reviews the current literature on antithyroid withdrawal prior to radioiodine ablation therapy. Caution should be taken when discontinuing antithyroid medications in patients with advanced heart failure as potentially lethal ventricular arrhythmias can ensue.
ABSTRACT
Left ventricular pseudoaneurysm is a rare complication associated with high morbidity and mortality when symptomatic and is usually managed aggressively to prevent or reduce risk of mortality. Herein, we present the case of a 73-year-old man who underwent coronary artery bypass grafting 10 years ago, now presenting with an inferior-posterior wall myocardial infarction complicated by pseudoaneurysm. This case highlights the need for individual clinical assessment of patient presentation with consideration for medical management in acute settings in patients with pseudoaneurysm of the left ventricle. Despite the natural history of rare complications with pseudoaneurysms such as rupture and potentially fatal cardiac tamponade, infections, and arrhythmias, it is important to note that pseudoaneurysms can present with coronary artery disease and congestive heart failure, and clinicians need to have an index of suspicion for pseudoaneurysms despite advancement in medical and interventional management of coronary artery disease.
ABSTRACT
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the young, particularly among athletes. Identifying high risk individuals is very important for SCD prevention. The purpose of this review is to stress that noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy and documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging provides complete visualization of the left ventricular chamber, allowing precise localization of the distribution of hypertrophy and measurement of wall thickness and cardiac mass. Moreover, with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with a family history of HCM and SCD.
