Thyrotoxicosis presenting as unstable angina and ventricular tachycardia with normal coronary arteries

A 38-year-old black woman with thyrotoxicosis, whose first symptom was angina pectoris, is described. Chest pain became progressively more frequent, and an unstable angina pattern developed. Angina attacks were associated with transient ischemic electrocardiographic changes and recurrent ventricular tachycardia was documented. Coronary angiography revealed no significant obstructive lesions. The patient became free of pain with antithyroid treatment and angina has not recurred.It is important to recognize that angina pectoris may be the major presenting symptom of thyrotoxicosis; unstable angina requires careful work-up and management including the performance of coronary angiography.