Severe Coronary Vasospasm Complicated by Thyrotoxicosis in Early Pregnancy

Although rare, thyrotoxicosis can precipitate anginal symptoms secondary to coronary vasospasm.

A woman presented in early pregnancy with new-onset retrosternal chest pain associated with nausea, vomiting, palpitations, and dyspnea. Further investigations revealed non-ST-segment elevation myocardial infarction secondary to coronary vasospasm owing to thyrotoxicosis. She was managed conservatively to restore euthyroidism with slow resolution of vasospasm.

Although the link between elevated thyroid hormone and coronary vasospasm is known, its occurrence during pregnancy is not well-documented. Likely a combination of pregnancy physiology, thyrotoxicosis, and coronary anatomical variance contributed to this severe case of coronary vasospasm. We highlight the importance of timely investigations and conservative management strategies during pregnancy.

Coronary vasospasm should be considered early for patients with anginal symptoms and a history of hyperthyroidism. Conservative management to restore euthyroidism should be recognized as the standard of care when treating pregnant women with this condition.