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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Myocardial infarction is very rare in women under the age of 40 amounting to only .3-.57% of cases according to Polish studies, and it is 10 times less in women than in men. Nevertheless, the use of contraceptives has been implicated in triggering it by diminishing the synthesis of antithrombin III. The use of alcohol can cause the reduction of the fibrinolytic activity of the blood. The case of a 33- year old female patient, a laborer in a brewery is presented, who sought medical help from the company medical staff after 2 weeks of generalized weakness, vertigo, chest pain, and loss of breath under strain. Physical labor had to be discontinued. EKG (electrocardiogram) showed extensive primary and secondary myocardial infarction in progress. She had been taking contraceptives for 3 weeks (1 pill of Femigen once a day). She was drinking 50 g of alcohol daily in the form of 1 liter of beer. She did not smoke, and no circulatory disorder was ascertained. Laboratory tests showed no disorder of aminotransferase or LDH activity, but fibrinogen level (23.5 mcmol/1), antithrombin III level (.124 g/l), and fibrinolysis time (320 minutes) values were abnormal. There was no disorder in the lipid and carbohydrate metabolism, and thyroid hormone level was normal. traditional therapy was prescribed for 2-3 weeks of the infraction: nitrates, rest and avoidance of physical exertion. After administration of castor oil, 2 weeks late an EKG test showed the normalization of all parameters of blood coagulation, and the HDL cholesterol level also dropped. The concomitant use of contraceptives and alcohol can increase the risk of myocardial infraction, therefore they should not be used together, but if such a situation occurs, the control of blood coagulation parameters must be undertaken.
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PMID:[A case of extensive myocardial infarction in a young woman as a complication of oral contraceptives and alcohol]. 245 8

There is a clinical dilemma in the treatment of patients with hypothyroidism and coronary artery disease; excess thyroid hormone administration may exacerbate anginal symptoms, and yet inadequate thyroid replacement may induce congestive heart failure. A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism is described in this paper. A 55 year-old woman with this complication initially received thyroid replacement therapy under strict monitoring. Forty days after the start of the thyroid replacement therapy, serum levels of thyroid hormone had reached the normal range, and then coronary artery bypass grafting was successfully performed. She recovered without any complications, and is now free from chest pain in spite of thyroid replacement therapy.
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PMID:A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism. 276 Oct 75

A 52-year-old man with myxedema was evaluated for anterior chest pain that was considered to be compatible with myocardial ischemia. The night after admission he developed extreme bradycardia, hypotension, and apneic episodes lasting up to 25 s. Continuous positive airway pressure and administration of medroxyprogesterone acetate prevented further episodes and relieved much of the somnolence and lethargy that had contributed to the evidence for myxedema. Alveolar hypoventilation caused by decreased sensitivity to carbon dioxide, inadequate central neural drive, peripheral muscle force, and obesity all may have contributed to the apnea. Chest pain has not recurred, and results of electrocardiography have remained normal following full thyroid hormone replacement. The early recognition of myxedema causing sleep apnea will allow specific treatment to avoid the cardiovascular risks related to prolonged apnea and will help avoid confusion with other etiologies of cardiovascular abnormalities.
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PMID:Extreme bradycardia during sleep apnea caused by myxedema. 363 55

We encountered 2 patients with thyrotoxicosis accompanied at its onset by progressive angina. The ST segment was elevated in one patient and depressed in the other patient during the spontaneous attacks. Coronary arteriographic findings were normal during control, and spasm was induced by ergonovine. No patients had chest pain even without antianginal medication after successful treatment of thyrotoxicosis. The coronary artery may become sensitive to spasm during thyroid hormone excess even in cases without significant coronary artery disease and previous chest pain.
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PMID:Vasospastic angina in thyrotoxicosis--case reports. 366 11

A 49-year-old woman with bronchial asthma was followed up at our hospital. After 3 years, she experienced an attack of chest pain with ST elevation in the precordal leads of electrocardiography. After admission, the chest pain and ST elevation disappeared, but the chest pain recurred after 6 days. Coronary angiography revealed no significant stenosis in the coronary arteries. After discharge, she had the chest pain repeatedly. ST elevation in the II, III, aVF leads was recorded. The diagnosis was coronary multispasm. The chest pain was refractory to medical therapy. Hypereosinophilia developed and bronchial asthma worsened. After steroid administration, the angina and bronchial asthma ceased. She has lost about 15 kg during 1 year. Laboratory data revealed low thyroid-stimulating hormone, high thyroid hormone, positive thyroglobulin antibody, and negative thyroid-stimulating hormone receptor antibody. The diagnosis was chronic thyroiditis. The multi-vasospastic angina refractory to medical therapy was caused by the hyperthyroid stage of chronic thyroiditis and hypereosinophilia.
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PMID:[Multi-vasospastic angina refractory to medical therapy caused by hyperthyroid stage of chronic thyroiditis and hypereosinophilia: a case report]. 1080 26

The purpose of this study was to investigate whether thyroid hormone levels have any predictive value for mortality in patients presenting to the emergency department with acute myocardial infarction (AMI). Three groups of patients admitted to the emergency department within the 11-month study period were considered eligible: 95 patients with chest pain and proven AMI, 26 patients with chest pain and no AMI, and 114 patients who served as controls with no evidence of any major disease. Cardiac enzymes and the following thyroid hormones were analyzed and compared between groups, regarding effects of historical and demographic factors: thyrotrophin, free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Sixteen patients with AMI (16.8%) died within the study period. Troponin T and creatine kinase-B with an M-type subunit levels were significantly higher in the nonsurvivors when compared with survivors. Survivors in the AMI group had higher TT3, TT4, and lower FT4 levels, while the nonsurvivors in the AMI group had higher thyrotrophin and lower TT3, FT3 and FT4 levels than controls. In the AMI group, the nonsurvivors had lower TT3 and FT3 levels than the survivors. A history of diabetes mellitus and/or angina, TT3, or FT3 was an independent predictor of mortality. TT3 and FT3 appear to be independent prognostic factors in patients with AMI.
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PMID:Prognostic value of thyroid hormone levels in acute myocardial infarction: just an epiphenomenon? 1633 Sep 14

A 47-year-old male was admitted to our clinic with the complaints of chest pain, limitation of cervical movements, progressive dyspnea, and painless cervical mass. The cervical mass dimensions were approximately 15 x 20 x 25 cm. Laboratory studies revealed a recurrent hyperthyroid state. After the thyroid hormones were maintained in a euthyroid condition, a coronary angiogram was made. It revealed progressive ischemic heart disease. Combined cardiac surgery and total thyroidectomy were performed. The postoperative course was uneventful without any of the problems associated with hyperthyroidism or hypothyroidism. Combined thyroid and cardiac surgery is feasible with little risk for both operations if the perioperative levels of the thyroid hormone are maintained in a euthyroid or hypothyroid state.
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PMID:Combined coronary arterial bypass graft and thyroidectomy in a patient with giant goiter: how reliable is it? 1728 77

Thyroid hormones have many effects on the heart and vascular system. Although cardiac output is reduced in hypothyroidism, heart failure is relatively rare because there is a lower demand for peripheral oxygen delivery. Hypothyroidism may also result in accelerated atherosclerosis and coronary artery disease. We report the case of a 55-year-old man with severe heart failure associated with severe longstanding untreated hypothyroidism. The patient was admitted for shortness of breath and chest pain. On presentation, signs and symptoms of severe hypothyroidism and heart failure were noticed. The electrocardiogram showed sinus bradycardia and ischemia. Thyroid stimulating hormone was extremely elevated and thyroid hormone levels were undetectable. A cardiac ultrasonography exam revealed abnormalities of the left ventricular dimensions and function consistent with dilated cardiomyopathy. Coronary angiography showed severe multivessel disease. Coronary by-pass was deemed necessary, but surgery was postponed because of severe heart failure. After an increasingly downhill clinical course, the patient died, eight month after his initial presentation, owing to severe heart failure. This patient represents an example of an overlooked diagnosis of severe hypothyroidism, rarely encountered nowadays, leading to dramatic consequences.
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PMID:Heart failure and dilated cardiomyopathy associated with severe longstanding untreated hypothyroidism. 1796 46

Thyroid hormone has many effects on the heart and cardiovascular system. Thyrotoxicosis is associated with increased cardiovascular morbidity and mortality, primarily due to heart failure and thromboembolism. However, the relationship between thyroid hormone excess and the cardiac complications of angina pectoris and myocardial infarction remains largely speculative. Moreover, few studies have been reported on the effect of thyroid hormone levels within normal range on coronary artery disease (CAD). Therefore we examined the association of thyroid function with coronary artery diseases in euthyroid angina patients. Total 192 subjects (mean age; 60.8 yrs) were enrolled in which coronary angiograms were performed due to chest pain. We measured free thyroxine (FT(4)), thyroid stimulating hormone (TSH), serum lipid levels and high-sensitivity C-reactive protein (hsCRP) levels and analyzed their association with the presence of CAD. Serum FT(4) levels were higher in patients with CAD compared with the patients without CAD (1.31 +/- 0.30 vs 1.20 +/- 0.23, p = 0.006), and high FT(4) level was associated with the presence of multi-vessel disease. Multivariate analysis showed that age (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.07, p = 0.007), hypertension (OR 2.04; 95% CI 1.06-3.90, p = 0.036) and FT(4) (OR 4.23; 95% CI 1.12-15.99, p = 0.033), were the determinants for CAD. The relative risk (RR) for CAD in highest tertile of FT(4) showed increased risk compared with the lowest tertile (RR 1.98; 95% CI 0.98-3.99, p<0.001). Our study showed that FT(4) levels were associated with the presence and the severity of CAD. Also, this study suggests that elevated serum FT(4) levels even within normal range could be a risk factor for CAD. Further studies will be necessary to confirm the relationship of thyroid function and CAD.
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PMID:Higher serum free thyroxine levels are associated with coronary artery disease. 1849 53

Resistance to thyroid hormone (RTH) is a rare disease characterized by non-suppressed TSH in spite of high free thyroid hormone levels. Up to date, in the literature, there are more than 600 RTH cases, but co-incidental hypophyseal adenoma was reported in only 1 case. In the literature, despite reported cases with thyrotropinoma accompanying RTH, we could not find a case with somatotropinoma accompanying RTH. Here, we report a 34-yr-old male patient, who was admitted to the hospital with complaints of dyspnea, chest pain, and palpitation in 2003. His alpha- subunit value was normal and the alpha-subunit/TSH molar ratio was <1. His response to TRH stimulation test was normal. His TSH level was suppressed in the T3 suppression test. Hypophyseal magnetic resonance imaging showed a 6-mm hypophyseal microadenoma. Levels of all anterior hypophyseal hormones, including GH and IGF-I, were normal. Oral glucose tolerance test (OGTT)-GH suppression test was normal. The patient was followed with the diagnosis of RTH and incidental hypophyseal adenoma. After 3 yr, because of high levels of IGF-I: 901 ng/ml (68-324), the OGTT-GH suppression test was reported and no suppression was detected. Thus, the patient was referred to surgery with the pre-diagnosis of RTH and acromegaly. Immunohistochemistry was showed as strong GH staining with low Ki 67 index while TSH and other anterior hypophyseal hormones stainings were negative. Post-operative thyroid hormones were still high.
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PMID:Somatotropin adenoma and resistance to thyroid hormone. 1954 50


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