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Aorto-coronary dissection during angioplasty in a patient with myxedema
1First Department of Internal Medicine, Mie University, Tsu, Japan. ryuji@clin.medic.mie-u.ac.jp
Insights
Hypothyroidism may increase the risk of aorto-coronary dissection, a serious complication during cardiac catheterization. This case highlights the potential dangers and need for careful patient selection.
Area of Science:
- Cardiology
- Endocrinology
Background:
- A 67-year-old male with hypothyroidism and hypertension presented with exertional angina.
- Coronary angiography was indicated due to persistent angina despite medication.
Observation:
- Coronary angiography revealed significant stenosis in the right coronary artery.
- A spiral aorto-coronary dissection occurred during angioplasty.
- Emergency stenting did not fully contain the dissection, which extended towards the brachiocephalic artery.
Findings:
- The dissection's false lumen thrombosed and resolved with conservative management.
- Chronic hypothyroid insufficiency is proposed as a potential risk factor for this complication.
Implications:
- Aorto-coronary dissection is a life-threatening complication of cardiac catheterization.
- Hypothyroidism may predispose patients to this adverse event, warranting further investigation.
- This case underscores the importance of considering endocrine status in cardiovascular interventions.
Abstract:
A 67-year-old man with overt hypothyroidism and medically controlled hypertension was admitted for coronary angiography because of exertional angina. His triiodothyronine (T3) and thyroxine (T4) levels had been low for 4 years. Although signs and symptoms of hypothyroidism were apparent, his hypercholesterolemia was mild. Coronary angiography revealed an eccentric stenosis in the distal portion of the right coronary artery and it was decided to perform angioplasty because his angina had continued in spite of medication. The dissection appeared at the lesion site after the first nominal inflation, and a subsequent image disclosed a spiral dissection from the dilated site to the aortic sinus and peripheral coronary artery. Although emergency stenting could not prevent the extension near the origin of the brachiocephalic artery, the false lumen thrombosed and then diminished with conservative therapy. Aorto-coronary dissection is potentially life-threatening and has been recently reported as a complication during cardiac catheterization procedures. Chronic hypothyroid insufficiency may be one of the risk factors for this complication.