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Cardiovascular Intensive Care Management from a Case Study - A Case of Thyroid Crisis in a Woman in her 40s Presented with Cardiogenic Shock

Circulatory and systemic management of patients with cardiogenic shock is directly related to the patient's life, but there are also severe cases that are not covered in the guidelines, and the findings from case reports may be useful in many cases.

In the "Cardiovascular Intensive Care Management through Case Studies," focusing on the acute management of cardiovascular diseases, the heart team and intensive care team at each institution shared their thoughts on how they arrived at what they considered to be the optimal treatment plan in the form of case presentations, and together with the moderator and discussants, we thoroughly discussed cardiovascular intensive care management. We would like to introduce some of the cases presented at the forum. This time, we present a case of a woman in her 40s who presented with cardiogenic shock due to thyroid crisis and required intensive care management.

Dr. Yukiko Hashimoto, Saitama Citizens Medical Center.

Case Example

Female in her 40s

Chief complaint

Fever, restlessness

Present medical history

Six months before coming to our hospital, she had been suffering from fever, malaise, indirect pain, and fatigue. She became angry, but we thought it was menopausal symptoms and kept an eye on her. Her appetite decreased and she lost weight. Due to a change in skin tone, she visited a dermatologist, but was under observation. She felt more heat than usual in summer. At 1:00 a.m. on the day of her visit, she complained of pain and heat. She was restless and had difficulty moving, so her family called for emergency medical assistance.

Medical history

Nothing to note,

No abnormalities noted after 3 deliveries.

Medication

None

Allergies

Hay fever

Physical examination

Vitals at presentation

Marked tachycardia, tachypnea, and fever were noted.

BP 140/66mmHg,

HR 156/min,

RR 38times/min,

SPO₂ 98% (10L reservoir mask),

BT 41.6°C,

GCS E4V2M6

Height 165cm,

Weight 57.5kg,

BMI 21.5

[Head and neck]

Bilateral ocular protrusion,

Yellowing of the conjunctiva,

Diffusely enlarged thyroid gland,

Thyroid diffusely enlarged, vascular murmur

[Thoracic region]

Respiratory sounds: decreased in both lower lung fields

Heart sounds: Tachycardia makes it difficult to hear heart murmur.

[Abdomen]

Flat, slightly firm, no obvious tenderness on palpation

[Extremities]

Bilateral lower legs with indurated edema,

Indurated oedema in bilateral lower legs, marked generalized lupus

Based on the patient's history and physical examination, hyperthyroidism and thyroid crisis were suspected.

Echocardiography Eyeball EF 60%, dart MR, sever TR There was a finding of left ventricular decom...

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