Key result
The addition of ivabradine successfully controlled heart rate within 48 hours in a 37-year-old woman with thyrotoxicosis and congestive heart failure refractory to maximal beta-blocker therapy.
Why the study?
Heart rate in thyrotoxicosis may be difficult to control even with maximal doses of propranolol, alerting physicians to ivabradine as an alternative option.
Does ivabradine improve heart rate control in patients with thyrotoxicosis and heart failure uncontrolled by beta-blockers?
Case Report (n=1)
Does ivabradine improve heart rate control in patients with thyrotoxicosis and heart failure uncontrolled by beta-blockers?
Ivabradine may be an effective adjunctive therapy for controlling heart rate in patients with thyrotoxic cardiomyopathy and thyroid storm when beta-blockers are insufficient.
May aid refractory tachycardia control in thyrotoxicosis; hypothesis-generating and requires prospective trials.
BACKGROUND: Beta-blockers, mainly propranalol, are usually administered to control heart rate in patients with thyrotoxicosis, especially when congestive heart failure presents. However, when thyrotoxicosis is not controlled, heart rate may be difficult to control even with maximal doses of propranolol. This presentation alerts physicians to the possibility of using ivabradine, a selective inhibitor of the sinoatrial pacemaker, for the control of heart rate. CASE PRESENTATION: We present a 37-year-old woman with thyrotoxicosis and congestive heart failure whose heart rate was not controlled with a maximal dose of beta blockers during a thyroid storm. The addition of ivabradine, a selective inhibitor of the sinoatrial pacemaker, controlled her heart rate within 48 hours. CONCLUSION: Ivabradine should be considered in patients with thyrotoxicosis, including those with heart failure, in whom beta blockers are insufficient to control heart rate.
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Frenkel et al. (2022) conducted a case report in Thyrotoxicosis and congestive heart failure (n=1). Ivabradine was evaluated on Heart rate control. The addition of ivabradine successfully controlled heart rate within 48 hours in a 37-year-old woman with thyrotoxicosis and congestive heart failure refractory to maximal beta-blocker therapy.
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