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Sinus arrest following diuretic therapy in a patient with myxedema and hypertension.

A 65-year-old female patient suffering from hypertension and myxedema due to chronic thyroiditis developed anginal attacks under trichlormethiazide therapy. The ECG revealed a SA block with reciprocal beats and aberrant ventricular conduction in a form of bigeminy. Upon substitution of desiccated thyroid for the antihypertensive drug, the anginal attacks subsided, the conduction disturbances disappeared and the blood pressure returned to normal without hypotensive treatment. This observation suggests that replacement therapy should precede diuretics in hypertensive patients with myxedema.