open access

Vol 14, No 2 (2019)
Case Reports
Published online: 2019-05-22
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Atrial fibrillation with rapid ventricular rate during thyroid storm

Agata Burakiewicz, Joanna Sokołowska, Kornelia Figuła, Dorota Zyśko
DOI: 10.5603/FC.2019.0037
·
Folia Cardiologica 2019;14(2):185-188.

open access

Vol 14, No 2 (2019)
Case Reports
Published online: 2019-05-22

Abstract

We present the case of an unconscious 81 year-old woman admitted to the Emergency Department with fever and significant tachycardia up to 210 bpm. The patient was referred by the general physician to the neurology department with suspected stroke. Atrial fibrillation (AF) with rapid ventricular rate was found. The causes of significant tachycardia, in this case, were complex and associated with dehydration, fever, infection and thyroid storm. It could be assumed that the deterioration of the patient’s general condition and a decreased fluid intake had caused hypertonic dehydration which could have led to further acceleration of the heart rhythm and loss of consciousness.  Thyroid function tests are indicated in all cases of paroxysmal AF. In the presented case, the suspicion of thyroid storm was based on the results of analysis and it was confirmed later by the results of free traction of thyroid hormones’ levels. The very fast ventricular rate was related to metabolic disorders and the influence of thyroid hormones on the electrophysiological properties of the atrioventricular junction. In order to stabilise the condition of the patient, passive oxygen therapy, an antipyretic drug, the correction of water and electrolyte disturbances, and digoxin were administered. This treatment improved the patient’s general condition and state of consciousness, resulting in slowing heart rate and respiratory rate. 

Abstract

We present the case of an unconscious 81 year-old woman admitted to the Emergency Department with fever and significant tachycardia up to 210 bpm. The patient was referred by the general physician to the neurology department with suspected stroke. Atrial fibrillation (AF) with rapid ventricular rate was found. The causes of significant tachycardia, in this case, were complex and associated with dehydration, fever, infection and thyroid storm. It could be assumed that the deterioration of the patient’s general condition and a decreased fluid intake had caused hypertonic dehydration which could have led to further acceleration of the heart rhythm and loss of consciousness.  Thyroid function tests are indicated in all cases of paroxysmal AF. In the presented case, the suspicion of thyroid storm was based on the results of analysis and it was confirmed later by the results of free traction of thyroid hormones’ levels. The very fast ventricular rate was related to metabolic disorders and the influence of thyroid hormones on the electrophysiological properties of the atrioventricular junction. In order to stabilise the condition of the patient, passive oxygen therapy, an antipyretic drug, the correction of water and electrolyte disturbances, and digoxin were administered. This treatment improved the patient’s general condition and state of consciousness, resulting in slowing heart rate and respiratory rate. 
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Keywords

atrial fibrillation; dehydration; thyroid storm

About this article
Title

Atrial fibrillation with rapid ventricular rate during thyroid storm

Journal

Folia Cardiologica

Issue

Vol 14, No 2 (2019)

Pages

185-188

Published online

2019-05-22

DOI

10.5603/FC.2019.0037

Bibliographic record

Folia Cardiologica 2019;14(2):185-188.

Keywords

atrial fibrillation
dehydration
thyroid storm

Authors

Agata Burakiewicz
Joanna Sokołowska
Kornelia Figuła
Dorota Zyśko

References (9)
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