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Table 1 Timeline

From: Delayed diagnosis of dilated thyrotoxic cardiomyopathy with coexistent multifocal atrial tachycardia: a case report

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
  1. MAT: Multifocal atrial tachycardia, IABP: Intra-aortic balloon pump, LVSD: Left ventricular systolic dysfunction