ABSTRACT : According to 1995 WHO/ISFC task force report, thyrotoxic cardiomyopathy is defined as myocardial damage caused by toxic effects of abundant thyroid hormones. It is a life threatening complication occuring in 1% of patients with thyrotoxicosis. It is associated with disturbances in cardiac rhythm, dilatation of cardiac chambers, systolic and diastolic dysfunction and pulmonary artery hypertension. Most cases respond to treatment withantithyroid drugs but, one–third cases of dilated thyrotoxic cardiomyopathy persist even after attaining euthyroid state. Atrial fibrillation develops in about 2-20% of patients with thyrotoxicosis. Apathetic thyrotoxicosis is an uncommon manifestation of thyrotoxicosis and is more common in elderly. It is characterised by apathy, depression, muscle weakness and cardiac manifestations. The aim of reporting this case is to present the rare occurrence of apathetic thyrotoxicosis with thyrotoxic cardiomyopathy in a patient with already diagnosed rheumatic heart disease. This is a case of a 55 year old woman with rheumatic valvular disease who was asymptomatic. She suddenly developed exertional dyspnoea following which she was diagnosed to have toxic multi nodular goitre with dilated thyrotoxic cardiomyopathy and atrial fibrillation with fast ventricular rate. Ventricular rate was not controlled even after attainingeuthyroid state. Total thyroidectomy was done following which ventricular rate came down dramatically. In literature, we have not come across any reports regarding anaesthetic management of a patient with thyrotoxic cardiomyopathy with underlying rheumatic heart disease.

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CONCLUSIONS : NA.SINCE IT IS A CASE REPORT