Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8127
Peer-review started: May 9, 2021
First decision: June 5, 2021
Revised: June 16, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: September 26, 2021
Acute coronary syndrome (ACS) encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia. Recent studies have revealed that thyroid function is closely related to ACS. However, only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.
A 33-year-old man, who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease, experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity. As the symptoms worsened at 21 d prior, he went to a hospital for treatment. The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves. Based on these findings and his symptoms, the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2, 2020. He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism. A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents, thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism. The 9-mo follow-up showed favorable results.
This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.
Core Tip: We present a case of an acute coronary syndrome due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism in a 33-year-old man. Patients with thyrotoxicosis-induced acute coronary syndrome (ACS) are very special, and almost all reported cases have been associated with Graves’ disease. Coronary angiography usually shows zero disease, and coronary artery spasm occupies a large proportion of data, which is contradictory with this case that ACS is accompanied by atherosclerosis. In this case ,we find that intensive drug therapy and implant-free interventional therapy are better options for patients with ACS and hyperthyroidism.