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Leucopenia and atrial fibrillation: Rare presentations of thyrotoxicosis in the first trimester

gram showed left ventricle dilatation with diffuse hypokinesia and left ventricular ejection fraction of 42%. The patient was discharged taking acetylsalicylic acid (100 mg) and atenolol (50 mg) daily for follow-up as an outpatient. Repeated episodes of angina pectoris prompted the decision for caesarean section at 36 weeks, a normal 2,350 g female infant being delivered. On postpartum day 1, she had sporadic episodes of supraventricular tachycardia, hypokalaemia, elevated cardiac enzymes and electrocardiogram evidence of anterior re-infarction. Medication with acetylsalicylic acid, clopidogrel, enoxaparin, atenolol, captopril, nitroglycerine, atorvastatin and bromocriptine was started. On day 6, coronary arteriography revealed 99% stenosis of the anterior descending artery; ventriculography showed diffuse hypokinesis and left ventricular ejection fraction of 41%. A successful therapeutic angioplasty with placement of a stent was performed. She was discharged on day 9 with the same medication.