Coronary Artery Bypass with Myxedema

Introduction Hypothyroidism increases the risk of cardiovascular complications in patients scheduled for coronary artery bypass grafting. Atrial fibrillation is one of its cardiac complications. Case Report Our 45-year-old male patient was admitted to the Emergency Medicine Clinic of our hospital with chest pain that started in the left arm and extended to the chin 2 days ago. It was noted that the patient had hypothyroidism, but did not have any medication for the disease. On physical examination, dry and pale skin, sparse coarse hair, non-pitting edema were diagnosed with acute coronary artery disease. No signs of ischemia were observed on the ECG at the time of admission, but bradycardic sinus rhythm was recorded. The patient was started to be followed up with the diagnosis of NON-ST myocardial infarction. Nitroglycerin 0.25 - 2 mcgr/h and morphine 2 mg were administered intravenously to the patient whose anginal complaints continued after admission. Anginal complaint continued was operated in 1:1 mode by attaching an intraaortic balloon pump (Maquet Sensation 7Fr 40 cc, Datascope CS300 console) via the left femoral artery. Surgery procedure: The patient was performed with median sternotomi (aortic, two-stage cannulation). While the patient was cooled to 32 degrees and given blood cardioplegia (St. Thomas II) and applied topical cold. After distal anastomoses were performed with saphenous vein graft. Total cross-clamp time was 60 min. Epinephrine was given for bradycardia sinus rhythm. No cardiovascular complications were encountered while being followed in the intensive care unit. The patient was discharged on the 6th postoperative day. Conlucion: Our case, who was taken to emergency CABG operation with myxedema, was discharged without any cardiovascular, respiratory or metabolic complications both in the perioperative and postoperative periods. In this case, the major stress caused by cardiovascular surgery was successfully overcome by both the cardiovascular surgery team and the anesthesiology team.