Key result
IV diltiazem linked to hypotension and asystolic cardiac arrest in thyrotoxic storm with fast AF.
Why the study?
Guidelines for managing thyroid storm lack an algorithm for treating patients with thyrotoxic crisis complicated by low-output heart failure, posing a therapeutic challenge.
Case Report (n=1)
Intravenous diltiazem can precipitate cardiogenic shock and cardiac arrest in patients with thyrotoxic storm and underlying low-output heart failure.
IV diltiazem may precipitate asystole in thyrotoxic storm; single case leaves safe rate-control strategies open.
CLINICAL FEATURES: The patient we present is a 39-year-old woman with a history of hyperthyroidism who developed fast atrial fibrillation secondary to thyrotoxic storm. After the initiation of intravenous diltiazem drip, she developed hypotension, bradycardia, then asystole cardiac arrest. THERAPEUTIC CHALLENGE: It is well known that calcium channel blockers and beta blockers should be used with extreme caution if the patient with thyroid storm has decompensated heart failure with reduced ejection fraction. Despite this, it is recognized that guidelines for the management of thyroid storm do not include an algorithm of action in this situation. Thus, dealing with low-output failure during thyroid storm may pose a critical challenge. SOLUTION: A significant portion of patients with thyrotoxic storm have an underlying low-output cardiac failure. Early identification, proper hemodynamic monitoring, and administration of the agents with appropriate pharmacodynamic profile and therapeutic potentials are essential to avoid treatment-induced cardiogenic shock.
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Subahi et al. (2018) conducted a case report in Thyrotoxic storm with fast atrial fibrillation (n=1). Intravenous diltiazem was evaluated on Hypotension, bradycardia, and asystole cardiac arrest. Intravenous diltiazem administration in a 39-year-old woman with thyrotoxic storm and fast atrial fibrillation resulted in hypotension, bradycardia, and asystolic cardiac arrest.
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