CHEST Guidelines-A-70-Year-Old-Woman-Presenting-With-Diarrhea-and-I

A-70-Year-Old-Woman-Presenting-With-Diarrhea-and-I

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This case report details the medical presentation and treatment of a 70-year-old woman with comorbid conditions, including asthma, a renal transplant performed in 2010, and chronic paroxysmal atrial fibrillation. She was admitted to the hospital due to bloody diarrhea and other symptoms such as dyspnea, fatigue, weight loss, and hair loss. Initial tests did not reveal any significant obstructive coronary disease or ventricular dysfunction. However, her hospital course worsened following a colonoscopy, during which she developed rapid ventricular atrial fibrillation treated with multiple drugs, including amiodarone.<br /><br />Her laboratory studies indicated hyperthyroidism, with the thyroid-stimulating hormone at undetectable levels and an increased free T4, accompanied by high thyroid autoantibody levels. A thyroid ultrasound revealed multiple thyroid nodules. The administration of amiodarone, an iodine-rich medication, may have exacerbated her thyroid condition, which was subsequently stopped.<br /><br />The patient's condition deteriorated, leading to an in-hospital cardiac arrest, which was diagnosed as pulseless electrical activity cardiac arrest. Immediate resuscitation measures were successful. Subsequent imaging showed right heart dysfunction, including a dilated right atrium and right ventricle failure potentially linked to acute-on-chronic right ventricular failure. Tests ruled out a pulmonary embolism as a cause for the cardiac arrest.<br /><br />The patient's thyroid abnormalities contributed to the development of pulmonary arterial hypertension (PAH) and right ventricular failure, which are rare yet serious complications. Treatment focused on addressing her hyperthyroidism with medications like hydrocortisone and methimazole, while diuresis alleviated some cardiac symptoms. Her condition improved, highlighting the importance of promptly identifying and addressing thyroid dysfunction to resolve right heart failures. The case underscores the critical role of bedside ultrasound in guiding the management of complex clinical conditions like this involving end-organ failure and hormone-induced cardiopulmonary decompensation.

Keywords

hyperthyroidism

pulseless electrical activity

cardiac arrest

right ventricular failure

pulmonary arterial hypertension

amiodarone

thyroid nodules

renal transplant

atrial fibrillation

bedside ultrasound