A Case of Acute Heart Failure with Hyperthyroidism Showing Persistent Negative T Wave in Electrocardiogram.

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We report a case of acute heart failure showing unusual changes of electrocardiogram. Patient was a 75-year-old woman who was admitted because of palpitation and dyspnea. On admission, physical examination revealed severe hypertension, and chest X-ray demonstrated pulmonary congestion. Sinus tachycardia, left atrial overloading, and ST elevation in V1-V3 were found on the electrocardiogram. the findings suggesting hyperthyroidism were also found on laboratory data. Her blood pressure and symptoms due to heart failure were controlled with load reduction and antihypertension therapy, while negative T waves concomitant with prolongation of QT interval appeared and persisted in almost all leads of the electrocardiogram. Echocardiogram revealed hypokinesis of the apical wall on admission, which was improved thereafter, 123Iodine-metaiodobenzylguanidine (123I-MIBG) myocardial imaging demonstrated a decreased accumulation in the lateral, posterior, and apical wall in sub-acute phase, and the decreased accumulation in the posterior wall persisted in chronic phase. Angiogram showed normal coronary arteries, and there was no adrenal mass on abdominal computed tomography. In this case, both hyperthyroidism and hypertension might trigger the acceleration of sympathetic cardiac nervous system, which might induce myocardial injury with unusual changes of the electrocardiogram.
一般社団法人国立医療学会の論文