Published 9 March 2009, doi:10.1136/bmj.b955
Cite this as: BMJ 2009;338:b955

Letters

Fatal thyrotoxic cardiomyopathy

β blockers and decompensated heart failure

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The lesson of Soh and Croxson’s article was that β blockers may precipitate circulatory collapse in thyrotoxic patients with low output heart failure.¹ This lesson should be extended to state that there is no role for β blockade (especially intravenous) in acute heart failure no matter what the underlying cause.

The guidelines referenced by the authors as evidence for the established role of β blockers in controlling arrhythmias in heart failure apply to chronic stable heart failure.² Oral β blockade improves survival in patients with chronic stable heart failure^{3 4} but should be avoided in those with decompensated heart failure.⁵ Left ventricular systolic dysfunction associated with thyrotoxic cardiomyopathy frequently improves when the patient becomes euthyroid,¹ making appropriate management of these patients all the more important. Early involvement of all appropriate specialists is to be encouraged in such complex cases.

Cite this as: BMJ 2009;338:b955

¹ Department of Cardiology, Western Infirmary, Glasgow G11 6NT

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Competing interests: None declared.

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4. Hjalmarson A, Goldstein S, Fagerberg B, Wedel H, Waagstein F, Kjekshus J, et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 2000;283:1295-302.[Abstract/Free Full Text]
5. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008;29:2388-442.[Free Full Text]

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Fatal thyrotoxic cardiomyopathy in a young man

May Ching Soh and Michael Croxson
BMJ 2008 337: a531. [Extract] [Full Text]

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