Graves' disease–induced complete heart block and asystole

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Presentation transcript:

Graves' disease–induced complete heart block and asystole Majd A. El-Harasis, MBBS, Christopher V. DeSimone, MD, PhD, Marius N. Stan, MD, Christopher J. McLeod, MB, ChB, PhD, FHRS, Peter A. Noseworthy, MD, FHRS HeartRhythm Case Reports Volume 4, Issue 3, Pages 105-108 (March 2018) DOI: 10.1016/j.hrcr.2017.12.001 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiogram acquired from the patient on presentation, which shows complete dissociation of atrial and ventricular activity consistent with third-degree atrioventricular block. HeartRhythm Case Reports 2018 4, 105-108DOI: (10.1016/j.hrcr.2017.12.001) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Change in thyroid hormone levels with therapy. A: Change in free T4 (in ng/dL), and B: change in total T3 (in ng/dL), following initiation of methimazole (day 4 of hospitalization). Both indices were elevated on presentation and normalized with methimazole therapy. HeartRhythm Case Reports 2018 4, 105-108DOI: (10.1016/j.hrcr.2017.12.001) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Schematic outlining the cardiovascular effects of thyroid hormone (mainly mediated through T3). Thyroid hormone results in an increase in the transcription of molecules central to contractile function, such as α-myosin heavy chain and sarcoplasmic reticulum Ca2+-ATPase, which results in a positive inotropic effect. It also results in an increase in adrenergic response through increased transcription of β1-adrenergic receptors and guanine-nucleotide regulatory proteins, resulting in a positive chronotropic effect. The hormones also have peripheral vascular effects resulting in decreased systemic vascular resistance, which results in increased blood volume as a response through increased renal sodium reabsorption. All these effects combined result in an increase in cardiac output.5 HeartRhythm Case Reports 2018 4, 105-108DOI: (10.1016/j.hrcr.2017.12.001) Copyright © 2017 Heart Rhythm Society Terms and Conditions