Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three women with diabetes mellitus presented an unusual change in the skin on the distal and acral parts of the extremities, most distinctly on the upper surface of the hands. The surface was raised in small cushions but had the colour of intact skin. The skin felt doughy and swolen on palpation but there was no oedematous pitting. It had been suspected earlier that these skin changes indicated myxoedema or heart disease and the patients had been treated with diuretics. In all three cases, however, histological examinations revealed a more or less reduced, atrophic dermis with here and there an appreciable dislocation of the subcutaneous layer of fat, which with the sweat glands formed an intracutaneous herniation up against the epidermis. These histological changes explained the clinical picture of cushions in the skin. As these patients had diabetes mellitus and the histological picture also included vascular changes of the type associated with a diabetic microangiopathy, it is considered that this form of intradermal herniation of fat is yet another skin change which may be elicited by diabetes mellitis.
 ...
PMID:Intracutaneous herniation of fat in connection with microangiopathia diabetica. 68 22

A case of primary myxedema heart disease in an 84-year-old man is presented. His history and physical examination were typical of myxedema. Electrocardiographic changes showing generalized low voltage, nonspecific S-T segment and T-wave changes, and nodal rhythm are characteristic of the disease. The patient showed remarkable improvement after oral liothyronine (Cytomel) therapy.
 ...
PMID:Primary myxedema heart disease. 72 31

Emergency pericardiocentesis, guided by a two-dimensional echocardiography, was performed on twenty patients with symptomatic pericardial effusion of various types and causes. There were fourteen men and six women. The underlying causes were: primary lung cancer (6 cases), metastatic cardiac tumors (3 cases), tuberculosis (4 cases), complicated interventional procedures with cardiac chamber or vessel perforations (2 cases), dissecting aortic aneurysm (1 case), systemic lupus erythematous (1 case), idiopathic pericarditis (1 case), bacterial pericarditis (1 case), and myxedema heart disease (1 case). Seventeen cases were performed through the left xipho-sternal approach and 3 cases through the apical approach. None of the patients died as a result of these procedures. A two-dimensional echocardiogram is useful in diagnosing cardiac tamponade as well as in guiding pericardiocentesis, and obtaines highly positive results (20/20). The positive rate of pericardial fluid cytology for malignant cells was 89% (8/9), however, pericardial fluid cultures or direct smear for tuberculosis were negative (0/4). In cancer patients, the mean survival time following pericardiocentesis was 4.2 months (range, 1-7.8 months). We concluded that neoplastic involvement of the pericardium is the most frequent cause of symptomatic pericardial effusion. Pericardiocentesis assisted by a two-dimensional echocardiogram is safe and easy. In addition, pericarditis caused by TB is still significant and must be considered in every case in our nation.
 ...
PMID:Pericardiocentesis: a 20 patients study. 133 Feb 47

Thyroid storm is a rapid decompensation of severe hyperthyroidism which can best be described by the three criteria of hyperthermia, tachycardia and altered mental state with severe agitation. There has to be a precipitating factor such as infection, iodine contamination, surgery or even I-131 treatment. Severe hyperthyroidism not fulfilling the criteria of thyroid storm can also be an indication for emergency treatment, particularly in the elderly with heart disease. Suppressed serum TSH and elevated free T4 levels are essential to confirm the diagnosis. When rapidly available, radioiodine uptake of the thyroid can be useful. Therapy aims at rapidly reducing the active circulating hormone pool, hypermetabolic state, tachycardia, and finally hormone synthesis. Thyroid secretion can be blocked by ioipanoic acid or ipodate while hypermetabolic state can be reduced with beta-blockers or calcium channel-blockers. Treatment of hyperthyroidism in patients with iodine contamination is a real therapeutic challenge. Myxoedema coma, a complication of severe hypothyroidism, is defined by hypothermia (rectal temperature less than 36 degrees C), bradycardia, slow mentation, precipitating factor such as infection or drug overdose, and increased serum creatine phosphokinase levels. Diagnosis of severe hypothyroidism should be confirmed by serum measurements of TSH and free T4. Treatment consists of general supporting measures including rewarming, correction of serum electrolyte disturbances, and adequate alimentation. Thyroid hormone treatment should initially be aggressive using either 300-400 micrograms of T4 or 20-40 micrograms of T3 intravenously. Cortisone therapy may be added. Patients should be under close monitoring as arrhythmias and myocardial infarction are frequent complications of myxoedema coma and/or its treatment with thyroid hormones.
 ...
PMID:Thyroid emergencies. 173 98

Myxoedema has been considered a major anaesthetic risk which could be increased by concurrent heart disease. Thyroid ablation with the production of myxoedema has, in the past, been used to control intractable angina. Eight ablated patients (Group I) and five patients with heart disease and incidental hypothyroidism (Group II) presented for open heart surgery. Management included diazepam-narcotic anaesthesia in generally reduced doses, careful monitoring and the use of digoxin, steroids and I-thyroxin given during or after operation. All patients survived. A number of the anaesthetic considerations and potential problems with myxoedema are discussed.
 ...
PMID:Myxoedema and open heart surgery: anaesthesia and intensive care unit experience. 713 93

Authors examined 10 patients with untreated myxoedema. The disease lasted at least one year in seven cases. The etiology of disease was autoaggressive thyroiditis in 9 cases and was diagnosed by a high titre of antibodies against thyroglobulin. The levels of T4 and T3 were low in all cases, level of TSH was elevated. The mean level of T4 was 0.91 microgram/dl, of T3 43.5 ng/dl. The level of TSH was over 96 microU/ml in 7 cases, in rest over 54 microU/ml. In all cases ECHO examination was done: pericardial effusion was proved in 80%. 5 patients were followed during substitutional therapy. Clinical signs and laboratory test normalised in all 5 cases. ECHO finding improved: left ventricular SEF from 54.4 +/- 7.4% to 67.9 +/- 10.3%, Vcf 0.82 +/- 16 circ/sec to 1.32 +/- 0.37 circ/sec max PWVs from 43.8 +/- 6.8 mm/sec to 63.2 +/- 9.9 mm/sec. The etiology of myxoedema may play a role in the incidence of pericardial effusion either by influence of autoaggressive disease or, which seems more probable, by a complete failure of thyroid gland secretion with low not only T4 but T3, too. T3 receptors are supposed to play an important role in the myxoedema heart disease.
 ...
PMID:The advantage of the use of echocardiographic evaluation in hypothyroid patients. 739 89

The RTH syndrome is an instructive example of a receptor resistance syndrome. A typical case history is reported here. The patient had had symptoms for many years and was first diagnosed as having inappropriate secretion of TSH. Pituitary tumour was excluded. The primary symptom was palpitations and the patient was partially thyroidectomized many years ago on suspicion of thyrotoxicosis. She was then given substitutional Eltroxin, but, because of palpitations, the dose was reduced to almost zero, after which the patient contracted symptoms suggesting myxoedema. The thyroid values could not be used for clinical assessment, however the symptoms of myxoedema disappeared when the Eltroxin dose was increased to 75 micrograms/day. When the dose was increased further the heart symptoms became too troublesome. The patient had no signs of underlying heart disease.
 ...
PMID:[RTH syndrome--resistance to thyroid hormone syndrome]. 1157 81

Patients with hyperthyroidism usually present with symptoms of hypermetabolism with or without goitre and/or eye signs. Occasionally, however, the chief complaints are not immediately suggestive of hyperthyroidism. Patients with hyperthyroidism are described who presented with such atypical manifestations as periodic muscular paralysis, myasthenia, myopathy, encephalopathy, psychosis, angina pectoris, atrial fibrillation, heart failure without underlying heart disease, skeletal demineralization, pretibial myxedema, unilateral eye signs, and pitting edema of the ankles.
 ...
PMID:ATYPICAL MANIFESTATIONS OF HYPERTHYROIDISM. 1417 5

The myxoedema coma corresponds to the ultimate evolution of a hypothyroidism and is characterized by a major deficit in thyroid hormones responsible for a collapse of the metabolism. The preventive and curative treatment is based on the administration of thyroid hormones, whose benefits are opposed to the cardiovascular risks related to an iatrogenic hyperthyroidism for patients often old with cardiopathy. We report the case of a 92-year-old patient with unbalanced hypothyroidism and chronic cardiac deficiency, who presented a myxoedema coma in the postoperative period of an urgent digestive surgery. This observation illustrates the difficulties in treating patients with unbalanced hypothyroidism following emergency surgery, in the absence of consensus on the type and the amounts of thyroid hormones substitution.
 ...
PMID:[The myxoedema coma exists, we met it]. 1762 59