Iodine
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Cardiac arrest and thyrotoxicosis exacerbation : case report A 51-year-old woman developed cardiac arrest and had exacerbation of thyrotoxicosis following use of iodine based contrast load during coronary angiography. The woman was admitted with acute inferior ST-segment elevation ECG changes and jaw pain. Thereafter, emergency coronary angiography was performed with iodine-based contrast load [route and dosage not stated] that showed a culprit thrombotic occlusion of the mid right coronary artery, which was successfully recanalised following deployment of two stents. However, 2 days later, she developed ventricular fibrillation (VF) cardiac arrest, which was terminated after a single shock delivery. However, an ECG revealed new inferior ST-segment elevation following shock delivery. Anamnesis revealed that a year earlier, she was diagnosed with thyrotoxic Graves’ disease for which propylthiouracil therapy was initiated. Shortly after, she discontinued propylthiouracil and was lost to follow-up. At the current presentation, thyroid biochemistry revealed elevated free thyroxine, thyroid peroxidase and antibodies against the TSH hormone receptor and decreased TSH, which confirmed Graves’ disease thyrotoxicosis and thus, carbimazole was started. Later, she was discharged. Post-discharge, she experienced episodic rest angina. The woman’s rest angina was alleviated with nitroglycerin [glyceryl trinitrate] spray. Subsequently, an ECG showed that her angina correlated with dynamic ST-segment elevation. Repeat blood tests indicated ongoing thyrotoxicosis, and she was treated with increased doses of carbimazole, amlodipine and nitroglycerin, with good symptomatic effect. Based on these clinical presentation and findings, it was concluded that the iodine based contrast load used during coronary intervention resulted in exacerbation of thyrotoxicosis via the Jod-Basedow effect, which had provoked transient coronary vasospasm with ischaemic VF cardiac arrest along with episodic rest angina. Dhami A, et al. Coronary Artery Spasm-Induced Cardiac Arrest Precipitated by Iodine Contrast Load in Unknown Pre-Existing Graves' Disease. JACC: Cardiovascular 803500780 Interventions 13: e147-e149, No. 16, 24 Aug 2020. Available from: URL: http://doi.org/10.1016/j.jcin.2020.05.029
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Reactions 12 Sep 2020 No. 1821
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