Cardiogenic shock and hypothyroidism.

A 62 years old lady, nondiabetic, mild hypertensive on non-pharmacological measures, presented with alteration in consciousness of 2 hours duration. There was no history of pain in chest, dyspnea, sweating, fever, loose motion and vomiting; had not suffered from such episode in the past. On examination, she was in cardiogenic shock. Immediately O2 inhalation, intravenous normal saline, inotrop (dopamine) infusion started, hydrocortisone sodium succinate 200 mgm intravenous given and repeated in next five minutes. In the mean time EKG (Fig. 1), showed sinus node arrest third degree with nodal escape rhythm of 33 per minute with normal QRS and T wave morphology and normal QTc (QT, 0.560 sec., RR interval 1.880 sec. and QTc 0.408 sec.). Immediately intravenous atropine 0.6 mgm given, repeated after 5 minutes, 10 minutes and again after 30 minutes. Up to next one hour neither ventricular rate nor hypotension improved, intravenous atropine 0.6 mgm repeated. Cardiac enzymes, random blood sugar, renal function tests and serum electrolytes were normal. Lipidogram showed hypercholestermia (S. cholesterol 340 mgm%). Pacing facilities were not available at our center and since patient was haemodynamically unstable, so could not be shifted to tertiary center (which is about 110 Km. far away). During these initial two hours, neither patient condition improved, nor there was any change in electrocardiogram.