Abolished Vagal Tone Associated with Thyrotoxicosis Triggers Prinzmetal Variant Angina and Paroxysmal Atrial Fibrillation
Authors: Michele Emdin, Lorenza Pratali, Giorgio Iervasi
Journal: Annals of Internal Medicine (2000)

Letters18 April 2000Abolished Vagal Tone Associated with Thyrotoxicosis Triggers Prinzmetal Variant Angina and Paroxysmal Atrial FibrillationMichele Emdin, MD, Lorenza Pratali, MD, and Giorgio Iervasi, MDMichele Emdin, MDCNR Institute of Clinical Physiology; Pisa, Italy 56100 (Emdin)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Pratali)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Iervasi), Lorenza Pratali, MDCNR Institute of Clinical Physiology; Pisa, Italy 56100 (Emdin)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Pratali)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Iervasi), and Giorgio Iervasi, MDCNR Institute of Clinical Physiology; Pisa, Italy 56100 (Emdin)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Pratali)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Iervasi)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-8-200004180-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We describe an association among tachyarrhythmias, transient myocardial ischemia accompanied by electrocardiographic changes indicative of Prinzmetal angina (probably associated with coronary vasospasm [1]), and autonomic imbalance in a hyperthyroid patient.A 63-year-old man in whom a diffuse toxic goiter was newly diagnosed underwent 24-hour electrocardiogram recording because of palpitations. This monitoring showed paroxysmal atrial fibrillation with spontaneous restoration of sinus rhythm (113 beats/min, an average heart rate) and 38 episodes of ST-segment elevation (3 of which were accompanied by chest discomfort) in the precordial lead (duration ranged from 1 minute, 20 seconds to 3 minutes, 20 seconds; ...References1. Moliterno D, Rowan DeBold C, Robertson RM. Case report: coronary vasospasm—relation to the hyperthyroid state. Am J Med Sci. 1992;304:38-42. CrossrefMedlineGoogle Scholar2. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996;93:1043-65. CrossrefMedlineGoogle Scholar3. Parodi O, Simonetti I, L'Abbate A, Maseri A. Verapamil versus propranolol for angina at rest. Am J Cardiol. 1982;50:923-8. CrossrefMedlineGoogle Scholar4. Klein I, Ojamaa K. Thyrotoxicosis and the heart. Clin North Am Endocrinol Metab. 1998;27:25-35. CrossrefMedlineGoogle Scholar5. Yamasaki F, Sato T, Sugimoto K, Takata J, Chikamori T, Sasaki M, et al . Effect of diltiazem on sympathetic hyperactivity in patients with vasospastic angina as assessed by spectral analysis of arterial pressure and heart rate variability. Am J Cardiol. 1998;81:137-40. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Emdin)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Pratali)CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Iervasi) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByThyrotoxicosis and Coronary Artery Spasm: Case Report and Review of the LiteratureAngina vasospástica secundaria a tirotoxicosisThyrotoxicosis-Induced Vasospastic Angina 18 April 2000Volume 132, Issue 8Page: 679KeywordsAnginaAtrial fibrillationElectrocardiographyHeart rateIschemiaNitratesRadionuclide imagingTachycardiaThoraxThyroid hormones Issue Published: 18 April 2000 CopyrightCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...