Table 1 Timeline
Timeline | |
|---|---|
14 days prior to presentation | The patient experienced diarrhoea and nausea |
10 days prior to presentation | She began to feel dyspnoea on effort |
4 days prior to presentation | She experienced worsening dyspnoea and a nonproductive cough on deep breathing |
On emergent presentation | |
6:40:00 PM | She presented with worsening dyspnoea at the emergency department. Electrocardiogram showed MAT. Echocardiography revealed left ventricular dilatation and severe hypokinesis; the patient was diagnosed with dilated cardiomyopathy |
6:44:00 PM | She was treated for MAT with intravenous administration of adenosine triphosphate, verapamil, and landiolol, as well as multiple cardioversions, which were ineffective |
8:12:00 PM | She rapidly progressed to cardiogenic shock and respiratory decompensation, which required intubation and inotropic support |
9:35:00 PM | Emergent coronary angiography was unremarkable. An IABP was inserted |
11:59:00 PM | Amiodarone was started for refractory MAT |
Day 3 | IABP and administration of amiodarone successfully suppressed the recurrence of MAT |
Day 5 | She was weaned from the vasoactive agents, and anti-failure therapy was carefully induced |
Day 7 | She was weaned off IABP |
Day 8 | Endomyocardial biopsy was performed A workup for the unexplained tachycardia led to the correct diagnosis of thyroid storm |
Day 11 | Extubation and cardiac rehabilitation |
Day 31 | Thiamazole was induced |
Day 38 | Follow-up echocardiography demonstrated significant improvements in left ventricular systolic function and reverse remodelling |
Day 40 | Discharged to home |
Regular follow-up | She received treatment at our outpatient clinic to establish clinical euthyroidism |
Day 131 | Total thyroidectomy was performed; thyroid pathology was consistent with Graves' disease |
6-month follow-up 48-month follow-up | Full recovery of the LVSD was observed She remained clinically stable |