Hello, and thank you for your question! Regarding your concern I would say that hyperdynamic circulatory situations are commonly easier to manage than the opposite ones. First of all, we have to check out any possible culprit factor responsible for the situation. As you show the patient suffers from endocrine disorders, seems a hypothyroidism (don t know the medical history is it from a thyroid glands inflammation (autoimmune process) or not. Nevertheless the first thing to do is to check the blood levels of thyroid hormones; as the hyperdynamic state could be induced by that. As a general rule thyroid hormone intake is associated with Beta-blockers therapy. So the best thing to do is an etiological therapy if possible. So consul first your endocrinologist and after that your cardiologist. Hope to have beeb helpful to you. Greetings. Dr. Iliri