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Atrial Fibrillation as a Complication of Hyperthyroidism in 34 Years Old Woman: a Case Report Michael Jonathan1, Hizkia1, Levina Tri Ratana1, Arif Ridha2, Arinta Setyasari3, Prihati Pujowaskito4 1 Cardiology Intern at Dustira Hospital, 2Senior General Practitioner at Dustira Hospital , 3 Cardiologist at Dustira Hospital, 4Head of Cardiology Department at Dustira Hospital Introduction Hyperthyroidism is a well established cause of atrial fibrillation (AF) and occurs in 10 15% of patients with hyperthyroidism. Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes. Case A 34 year-old woman with chief complain of dyspnea and chest pain. On physical examination, we found blood pressure 100/70 mmHg, heart rate 160 beat/minute with irregularly irregular pattern, respiration of 30 times/minute, temperature of 36.7OC, oxygen saturation of 90%, non elevated jugular venous pressure, crackles in left and right lung on auscultation, and pretibial edema. On laboratory examination, we found free T4: 3.0 ng/dl (Normal range: 0.6-1.7 ng/dl), TSHs: 0.1 uU/ml (Normal range: 0.3-3.8 uU/ml), complete blood count, electrolyte and other parameter within normal limit. ECG recording was made and showed rate of 160 bpm, irregularly irregular. The result echocardiography is normal. Holter monitoring and coronary angiography were not executed due to financial issues. The patient was treated with oxygen 3 lpm (nasal canule), digoxin IV 1x1 ampule, furosemide IV 2x2 ampule, warfarin 1x2mg tablet, propylthiouracil 3x100mg tablet. On the second day of hospitalization, the patient felt better and digoxin IV switched to propranolol 2x10mg. The ECG was repeated and showed an AF NVR. After 1 more day of observation, the patient’s condition stabilized and she was then discharged home. Discussion Thyroid hormones exert their cardiovascular effects either directly through nuclear thyroid receptors or indirectly by influencing sympathoadrenergic system and altering peripheral vascular resistance. These effects result in increased heart rate, systolic hypertension, increased ventricular contractility and cardiac hypertrophy. Changes in electrophysiological characteristics of atria result in dysrhytmias, especially atria fibrillation, in patients with hyperthyroidism. Conclusion Atrial fibrillation is the most common cardiac arrhythmia other than sinus tachycardia encountered in hyperthyroidism. Treatment with anti-thyroid drugs and beta-blockers is indicated in most of the cases.
