Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare autopsy case of death due to thyroid crisis is reported. A 45-year-old lean woman with pigmentation of the skin was found dead at the seaside. The autopsy findings were as follows: The enlarged thyroid gland (35.5 g) had a histological finding of diffuse hyperplastic goiter (hyperthyroidism). The thymus (28.5 g) was enlarged and parenchymatous. The lymphocytes in the thymus and spleen were conspicuously proliferated, probably due to secondary adrenal cortex insufficiency. The adrenal cortex was slightly atrophic. Hemosiderin-laden macrophages in the lung, and centrilobular necrosis, microscopic bleeding, fibrosis, and nodular regenerative hyperplasia of the liver indicated the persisted heart failure. A small pericardial scar was found at the right ventricle of the heart (280 g), and the histological finding of the heart was only congestion. Acetone was detected in a relatively high concentration in the blood (72 micrograms/ml), urine (139 micrograms/ml), bile (32 micrograms/ml) and gastric contents (38 micrograms/g), probably due to metabolic disorder from thyroid crisis. In conclusion, the cause of death was diagnosed as sudden death due to thyroid crisis from hyperthyroidism.
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PMID:[An autopsy case of sudden death due to hyperthyroidism]. 226 15

A multicenter study was able to utilize 120 medical files of children born from mothers who presented an abnormal thyroid function, 67 euthyroid goiters, 29 hyperthyroidisms, and 24 hypothyroidisms. In the first case, whether or not an inhibiting treatment was initiated, all children were perfectly normal. In case of maternal hyperthyroidism, the risk of malformations is not increased, deaths in utero and mostly in utero growth delays (1 case in 2) are more frequent. At birth, the child may present a hyperthyroidism due to the effect of SAT with elevated TSH and a goiter, sometimes compressing and impairing breathing, or also a hyperthyroidism due to transplacental crossing of stimulating immunoglobulins with possibility of thyreotoxic crises and heart failure. The diagnosis could be made in utero in the presence of tachycardia or with T4 and TSH assays in the cord. In case of maternal hypothyroidism, usually the children have no problems and the risk of neonatal hypothyroidism is mostly present in premature infants if the maternal balance is poor (2 in 24 cases in our series). Finally, in the reference population, the risk of neonatal hypothyroidism remains 1 in 3600 and justifies systematic screening on the 5th day of life.
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PMID:[Children of hyper- and hypothyroid mothers]. 269 65

Because the presenting symptoms of hyperthyroidism are often misleading in elderly patients, diagnosis depends on a high degree of clinical suspicion. The presence of unexplained weight loss, atrial fibrillation, or heart failure (especially in a patient without a history of heart problems) justifies testing for thyrotoxicosis.
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PMID:Unexplained weight loss in an elderly patient. Delayed diagnosis of thyrotoxicosis. 281 11

New method for measuring plasma and urinary Na-K-ATPase inhibitor (ATPI) was developed. Plasma and urine were extracted with reversed phase cartridge column and sample was reconstituted by assay buffer. Na-K-ATPase inhibitory activity of sample was monitored by continuously recording the absorbance of NADH at 340 nm, which coupled to the dephosphorylation of ATP. Ouabain was used for standards of Na-K-ATPase inhibition and this standard showed good linearity ranged 5-100 nmol/ml. Using this new method, P-ATPI and U-ATPI were quantitatively evaluated and paradoxical Na-K-ATPase stimulating phenomenon which observed in conventional method (Hamlyn et al) was diminished. Adopting of this new method for measuring plasma(P-) and urinary(U-)ATPI, and radioimmunoassay for P- and U-digitalis-like substance(DLS)--using crossreactivity to anti digoxin antibody--, these substances were estimated in patients with essential hypertension (EHT), chronic heart failure(CHF), primary and idiopathic hyperaldosteronism(HA), hyperthyroidism(BA) and chronic renal failure(CRF). In EHT, U-DLS, P-DLS, U-ATPI, P-ATPI were significantly higher than those of control(C). In CHF and BA, U-DLS and -ATPI were also significantly higher than those of C. In HA, U-ATPI, DLS distributed in wide range, and a few patients showed high levels of U-DLS and -ATPI. In CRF, P-DLS and -ATPI levels were significantly higher than those of C in prehemodialytic state but P-ATPI was significantly decreased after hemodialysis. From these results it is suggested that 1) DLS and ATPI might contribute to the etiology of hypertension. 2) Volume expansion stimulates the secretion of DLS and ATPI. 3) Stimulatory effect of volume expansion and inhibitory effect of mineralocorticoid may be responsible for wide distribution of these factors in HA. 4) DLS and ATPI are not the same substances.
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PMID:[Endogenous digitalis-like substance and Na-K-ATPase inhibitor in cardiovascular and renal disease]. 283 14

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the middle-aged and elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation may dominate the clinical picture and mask the more classical endocrine manifestations of the disease. Pitfalls in diagnosis and the importance of early recognition and treatment are discussed. Despite experimental evidence for a short-term inotropic action of thyroid hormone excess, clinical data support the existence of a reversible cardiomyopathy in hyperthyroidism with impaired contractile reserve. Enhanced myocardial performance at rest primarily reflects the peripheral actions of thyroid hormone excess. Most, if not all, of the cardiac abnormalities return to normal once a euthyroid state has been achieved, although atrial fibrillation may persist in a minority. Optimum treatment requires rapid and definitive antithyroid therapy, usually using a large dose of radio-iodine, and rapid control of heart failure. Systemic anticoagulation is indicated in the presence of atrial fibrillation and should be continued until sinus rhythm has been present for at least three months, either spontaneously or after cardioversion.
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PMID:Hyperthyroid heart disease. 286 53

Iopanoic acid (1 g/d) was used together with propylthiouracil (1200 mg/d) in the treatment of a patient with very severe hyperthyroidism and associated cardiac failure. Although serum total T3 decreased by 75% within 48 h and reached normal after 72 h, free T3 levels did not fall to normal. Total and free T4 remained markedly elevated and features of hyperthyroidism persisted. Estimations of theoretical in vivo occupancy of nuclear thyroid hormone receptors, based on serum free T4 and free T3, suggest that the marked decrease in total T3 would not result in a corresponding decrease in thyroid hormone action. Hence, estimates of potential benefit from oral cholecystographic contrast agents, based only on measurements of total T3, may be unduly optimistic. When temporary agranulocytosis developed in this patient, the prior use of iopanoic acid, by markedly reducing thyroidal iodine uptake, restricted the therapeutic options. Caution should, therefore, be exercised in the use of iodine-containing contrast media as adjunctive antithyroid agents.
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PMID:Iopanoic acid is of minimal benefit in the treatment of severe hyperthyroidism: conclusions from a case study. 298 3

Experimental hyperthyroidism induced in rats by daily injections of 3,3',5,5'-tetraiode-L-thyroxine (0.5 mg/kg i.p.) for 14 days resulted in a significant increase in heart weight and heart weight/body weight ratio. Hemodynamic and morphological studies were performed in one group. Thyroxine-treated rats showed a characteristic cardiovascular hyperdynamic state, such as tachycardia and augmented rate of contraction, but no evidence of heart failure such as elevated end-diastolic pressures. The cardiac cells in hyperthyroid rats had a significantly larger diameter and more mitochondria than did those of the control rats. In another group the activities of cardiac enzymes involved in energy utilization and liberation were measured biochemically and compared with those of normal controls. Hyperthyroidism resulted in increased specific activity of cytochrome C oxidase and actomyosin ATPase in the myocardium. The specific activity of long-chain acyl-CoA synthetase, carnitine palmityl-transferase, carnitine acetyltransferase, malate dehydrogenase and citrate synthase showed a moderate to marked increment, whereas the specific activity of lactate dehydrogenase and pyruvate kinase remained at the control values. These results suggest that in hyperthyroid rat hearts the functions of both energy liberation and utilization systems are enhanced to meet the added workload. Moreover, the increased activity of the enzymes participating in fatty acid metabolism suggest that in thyroxine-induced hypertrophic and hyperdynamic rat hearts, fatty acids contribute more to the energy supply than do carbohydrates.
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PMID:Biochemical and morphological study of cardiac hypertrophy. Effects of thyroxine on enzyme activities in the rat myocardium. 315 81

Cardiac function is difficult to assess in patients with atrial fibrillation due to the widely fluctuating cycle lengths resulting in variable ventricular hemodynamics. With respect to ECG-gated blood pool scintigraphy, distortion of the time activity curve occurs due to a summation of irregular cycle lengths. Therefore, performing such a study has been regarded meaningless. To evaluate left ventricular function during atrial fibrillation using scintigraphic technique, a new processing algorithm was devised to make multiple gated images which are discriminated by the preceding R-R interval, and left ventricular filling and function curves were established. The left ventricular filling curve, obtained by plotting end-diastolic volume against the preceding R-R intervals demonstrated an impairment of blood filling in cases of mitral stenosis and constrictive pericarditis, which resolved after mitral commissurotomy in case of mitral stenosis. The left ventricular function curve, established by plotting stroke volume against end-diastolic volume, was analyzed according to indices such as "slope" and "position". Both of these indices were significantly reduced in relation to the severity of heart failure according to the NYHA's functional classification and cardiomegaly on chest radiography. On individual comparisons of underlying diseases, the indices decreased in the following order; lone atrial fibrillation, hyperthyroidism, aging, hypertension, mitral valve disease, ischemic heart disease, dilated cardiomyopathy and aortic regurgitation. The indices correlated closely with ejection fraction. In cases of mitral regurgitation, however, the function curves were situated to the right and above those of lone atrial fibrillation and decreased in slope despite the fairly well-maintained ejection fraction. After treatment with digitalis and/or diuretics, the function curves shifted to the left and upward. In conclusion, left ventricular filling and function curves based on a newly-devised algorithm of ECG-gated blood pool scintigraphy are of considerable clinical value in evaluating cardiac performance in patients with atrial fibrillation. They are widely applicable to the assessment of therapeutic and interventional effects.
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PMID:[Left ventricular function during atrial fibrillation assessed by left ventricular function curve using ECG-gated blood pool scintigraphy]. 350 42

Host factors play an important role in the dosing requirements of theophylline. Theophylline metabolism and clearance depend principally on liver cell function rather than on hepatic flow. The effects of acute hypoxemia require more study; however, patients with chronic obstructive pulmonary disease who have chronic hypoxemia appear to have some impairment of clearance. Clearance is variably and sometimes drastically reduced in patients with liver disease and heart failure, and is reduced by some viral infections. It is not impaired by renal failure. Current split-virus vaccine mixtures do not appear to affect clearance. Clearance is increased in patients with cystic fibrosis and hyperthyroidism. The depressed clearance seen in the severely ill patients who require intensive care improves with improvement in the patient's condition, but the individual factors involved have not been identified. An area requiring more study is the effect of pH on the apparent distribution volume for theophylline. In the presence of liver disease, heart failure, or serious illness, caution must be applied in theophylline dosing, with frequent monitoring of serum levels. Stable patients also warrant an initially conservative dose until serum levels are obtained to guide further dose adjustments.
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PMID:Effect of disease states on theophylline elimination. 353 54

Myocardial failure may complicate hyperthyroidism. Some authors consider that preexisting myocardial lesions are necessary for its development. We studied a case of myocardial failure, presenting as a dilated cardiomyopathy, complicating hyperthyroidism in a 57 year old woman. She had a bio-clinical evaluation and a haemodynamic study with endomyocardial biopsy of the left ventricule. No valvular or coronary disease were noted. The light and ultra-microscopic aspects of the myocardium were within normal limits. We conclude that preexisting myocardial lesions are not essential to the development of myocardial failure complicating hyperthyroidism.
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PMID:[Absence of ultra-structural histological lesions of the myocardium in cardiac insufficiency of hyperthyroidism]. 381 68


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