Impending myocardial ischaemia during thyroid storm diagnosed through Wellens' syndrome. 2022

Shinjan Patra, and Anupriya Kaliyappan, and Atul Kaushik, and Ayan Roy
Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

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.

UI MeSH Term Description Entries
D008297 Male Males
D010146 Pain An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS. Suffering, Physical,Ache,Pain, Burning,Pain, Crushing,Pain, Migratory,Pain, Radiating,Pain, Splitting,Aches,Burning Pain,Burning Pains,Crushing Pain,Crushing Pains,Migratory Pain,Migratory Pains,Pains, Burning,Pains, Crushing,Pains, Migratory,Pains, Radiating,Pains, Splitting,Physical Suffering,Physical Sufferings,Radiating Pain,Radiating Pains,Splitting Pain,Splitting Pains,Sufferings, Physical
D003251 Constriction, Pathologic The condition of an anatomical structure's being constricted beyond normal dimensions. Stenosis,Stricture,Constriction, Pathological,Pathologic Constriction,Constrictions, Pathologic,Pathologic Constrictions,Pathological Constriction,Stenoses,Strictures
D003324 Coronary Artery Disease Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause. Arteriosclerosis, Coronary,Atherosclerosis, Coronary,Coronary Arteriosclerosis,Coronary Atherosclerosis,Left Main Coronary Artery Disease,Left Main Coronary Disease,Left Main Disease,Arterioscleroses, Coronary,Artery Disease, Coronary,Artery Diseases, Coronary,Atheroscleroses, Coronary,Coronary Arterioscleroses,Coronary Artery Diseases,Coronary Atheroscleroses,Left Main Diseases
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013577 Syndrome A characteristic symptom complex. Symptom Cluster,Cluster, Symptom,Clusters, Symptom,Symptom Clusters,Syndromes
D013958 Thyroid Crisis A dangerous life-threatening hypermetabolic condition characterized by high FEVER and dysfunction of the cardiovascular, the nervous, and the gastrointestinal systems. Thyroid Storm,Thyrotoxic Crisis,Thyrotoxic Storm,Crisis, Thyrotoxic,Crisis, Thyroid,Storm, Thyroid,Storm, Thyrotoxic
D023921 Coronary Stenosis Narrowing or constriction of a coronary artery. Coronary Artery Stenosis,Coronary Stenoses,Artery Stenoses, Coronary,Artery Stenosis, Coronary,Coronary Artery Stenoses,Stenoses, Coronary,Stenoses, Coronary Artery,Stenosis, Coronary,Stenosis, Coronary Artery

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