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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a statistics including 954 patients with hyperthyroidism [correction of Huprotoncoses] treated between 1966-1989, the authors found 522 cases (54) with various associated cardiac disorders. Of these cases, 199 presented rhythm disturbances: extrasystolic arrhythmia, auricular fibrillation and flutter to which 34 postoperative arrhythmias are added. Cardiac insufficiency present in 46 cases was the main complication and end point of the various myocardial conditions. Ischemic cardiopathy (181 cases), arterial hypertension (98 cases) and rheumatic valvulopathies (9 cases), either isolated or dominating the clinical picture, complete the nosological spectrum of these disturbances. The frequency of associated conditions and the absence of some specific morphologic lesions suggest that thyrotoxicosis is rather an aggravating factor although in many cases the presence of a previous cardiac disease is excluded. The two objectives in the management of thyrocardiac diseases are the amelioration of cardiac condition and an endocrine balance. In the conditions of a careful selection and preoperative preparation, surgery gave good results consisting, in this series, in over 70% cures and ameliorations.
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PMID:[The cardiac manifestations in hyperthyroidism. The surgical implications]. 815 62

A patient with primary biliary cirrhosis had a dramatic deterioration in liver function with jaundice over 2 months as a result of development of Graves' disease. Clinical examination and radiological and cardiovascular investigations excluded heart failure and biliary obstruction as the cause of this deterioration. The patient's jaundice entirely reversed with treatment of hyperthyroidism, with bilirubin levels decreasing from 244 to 16 mumol/L (14.35 to 0.94 mg/dL). Deterioration in liver function in a patient with primary biliary cirrhosis as a result of hyperthyroidism has not previously been described.
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PMID:Reversible jaundice in primary biliary cirrhosis due to hyperthyroidism. 817 93

The prevalence of atrial fibrillation varies widely depending on the population studied. To understand the incidence of atrial fibrillation and its significance in relation to other diseases, 3 years (1989 through 1991) of consecutive hospital discharges from the neurology and internal medicine services at Henry Ford Hospital were studied. Of the 26,964 patients who qualified for analysis, 1346 (5%) had atrial fibrillation as 1 of their 5 recorded discharge diagnoses. Comparing the group without atrial fibrillation to those with atrial fibrillation, there were 51% males in both groups (p = 0.88). African-Americans comprised 33% of the patients with atrial fibrillation and 50% of the patients without atrial fibrillation (p < 0.001). The average age of those with atrial fibrillation was 72 +/- 13 years, and 58 +/- 18 years for those without atrial fibrillation (p < 0.001). Length of hospital stay was 9.6 +/- 8.6 days with atrial fibrillation and 7.6 +/- 9.2 days for those without atrial fibrillation (p < 0.001). After adjusting for the effects of age, significant positive associations were noted in those patients with atrial fibrillation whose co-existing condition was either stroke, heart failure, myocardial infarction, hyperthyroidism, or mitral valve disease. There was also a significant negative relationship between hypertension and atrial fibrillation. The most common of the 5 discharge diagnoses observed in patients with atrial fibrillation was congestive heart failure (40%), followed by hypertension (23%) and ischemic heart disease (21%). The existence of a comorbid disease in patients with atrial fibrillation is important, as it can influence medical management and prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidemiology of atrial fibrillation in patients hospitalized in a large hospital. 820 33

Hyperthyroidism and hypothyroidism are common disorders in the elderly and may remain unrecognised until a patient presents with an apparently unrelated problem. The finding of an elevated level of thyroid stimulating hormone (TSH) with a normal serum thyroxine (T4) level represents "subclinical hypothyroidism", which does not necessarily require treatment. Iodine can precipitate hyperthyroidism in patients with autonomous thyroid tissue and the iodine-rich antiarrhythmic agent, amiodarone, may cause either hyperthyroidism or hypothyroidism. The metabolism and clearance of numerous therapeutic agents is altered when thyroid status is abnormal, so that dose adjustment may be necessary. In cardiac failure secondary to hyperthyroidism, great care must be taken in prescribing beta-blockers and diuretics; dosage of digitalis preparations may need to be increased. Thyroid replacement therapy can aggravate myocardial ischaemia and it may be appropriate to consider coronary artery bypass grafting before hypothyroidism is fully corrected. Antithyroid drugs, surgery and radioactive iodine all have a place in the treatment of hyperthyroidism in the elderly, depending on factors such as disease severity and the characteristics of the goitre. T4 may be given together with an antithyroid drug in a "block-replace" regimen.
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PMID:Thyroid disease. 834 Nov 92

The effects of acute and chronic administration of propranolol and verapamil on heart rate and systolic time intervals were studied in 10 hyperthyroid patients and 10 normal subjects, both groups without signs of cardiovascular or pulmonary disease. In normal subjects iv propranolol reduced heart rate significantly, and both drugs increased the total electromechanical systole significantly without difference between the drugs. This effect was insignificant when the drugs were given orally. In hyperthyroid patients both drugs reduced heart rate significantly in acute and chronic administration, and no difference between the two drugs was found. Neither drug altered cardiac contractility as assessed by systolic time intervals. These results indicate that the metabolic effects of thyroid hormone on contractility were unaltered and unblocked by the drugs. None of the participants developed signs of heart failure. Verapamil can thus be used as an alternative to propranolol in the treatment of tachycardia in hyperthyroidism.
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PMID:The effects of propranolol and verapamil on hyperthyroid heart symptoms and function, assessed by systolic time intervals. 849 48

High cardiac output failure/state (HCOF) is regular feature of some illnesses e.g. thiamine deficiency, hyperthyroidism, severe anemia, Paget's disease or arteriovenous fistulae. HCOF in multiple myeloma is reported quite rarely. 31-year-old man was admitted because of fatigue, dyspnea and subfebrilities. Heart rate was 116/min, sinus rythm blood pressure 110/60 mmHg. Chest film showed cardiomegaly with sings of interstitial pulmonary edema, echocardiography mild dilatation of the left ventricle with hyperkinetic wall motion and small pericardial effusion. Hemoglobin was 104 g/l, leukocyte count 13.5 x 10(9)/l with 30% of plasmatic cells. Serum protein electrophoresis demonstrated a monoclonal gammapathy, X ray studies of the skelet multiple osteolytic lesions. Diagnosis of plasmocytic leukemia-form of multiple myeloma was established and chemotherapy (vincristine + adriamycine + dexamethason) was started. Patient cardiac status deteriorated. Cardiac catheterisation demonstrated mean righ atrial pressure of 25 mmHg, mean pulmonary artery pressure of 28 mmHg and pulmonary artery wedge pressure of 24 mmHg. Co was 20.0 l/min (C.I. 11.5 l/min/m2). In continuing of chemotherapy and symptomatic therapy for heart failure patients status gradually improved and complete remission of the myeloma and normalisation of cardiac parameters was achieved. Heart failure in multiple myeloma patients has been attributed to amyloidosis of myocardium, hyperviscosity syndrome, co-existing CAD or anthracycline toxicity. HCOF should be considered in patients with clinical evidence of heart failure and normal left ventricular function.
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PMID:[Hypercirculatory heart failure in a patient with plasmacytic leukemia]. 855 97

Percutaneous transvenous mitral commissurotomy (PTMC) was performed successfully without complications in 3 patients with severe mitral stenosis and hyperthyroidism. All 3 patients had pliable, noncalcified mitral valves. One patient who had been treated with methimazole for 6 months was still in a hyperthyroid state when she presented with intractable congestive heart failure and was found to have severe mitral stenosis. The heart failure improved immediately after PTMC, but the patient remained in New York Heart Association functional class 2 until a euthyroid state was achieved with I131 therapy. In the other 2 patients, hyperthyroidism was unsuspected at the time of PTMC. Unexpectedly suboptimal symptom improvement led to the diagnosis of hyperthyroidism 1 month after the intervention. In all 3 patients, PTMC resulted in an immediate hemodynamic and clinical improvement. However, complete clinical improvement occurred only when euthyroid state was achieved after antithyroid treatment. The present study suggests that PTMC is a safe and effective intervention modality in patients with coexisting hyperthyroidism and severe mitral stenosis. The procedure may be considered a therapeutic option in patients with hyperthyroidism and severe mitral stenosis.
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PMID:Percutaneous transvenous mitral commissurotomy in patients with mitral stenosis and coexistent hyperthyroidism. 863 21

The long-term results of 68 cases of thyrotoxic heart disease (THD) treated with 131I were analysed. 17 of 68 patients have been followed for 2-4 years, 32 for 5-9 years, 7 for 10-14 years, 8 for 15-19 years and 4 for 20-33 years. The mean period of follow up was 9 years. Of the 68 patients, 47 did not respond to antithyroid drug (ATD) therapy. Before 131I therapy, all the patients suffered from one or more of cardiac abnormalities caused by hyperthyroidism such as paroxysmal or permanent atrial fibrillation, cardiac enlargement, cardiac failure, frequent atrial or ventricular extrasystoles, angina pectoris and so on. All patients were given individualized therapeutic 131I dose of 2.59-4.44 MBq per gram of thyroid weight. The total 131I dose for patients was 85.1 MBq to 462.2 MBq. The long-term results showed that 55 cases were cured and 11 cases achieved complete remission. The total effective rate was 97 percent. There was no relapse of hyperthyroidism. Except that 4 cases of early hypothyroidism and 5 of delayed hypothyroidism were diagnosed, there were no other complications. The incidence of postradioiodine hypothyroidism at 5-9 years was 7.4 percent and at 10-33 years 20 percent. Our results indicate that 131I is a simple, safe, economic and effective treatment for THD. Pre-treatment with ATD for hyperthyroidism with cardiac complications is not necessary. 131I should be considered as the treatment of first choice for hyperthyroidism with cardiac abnormalities.
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PMID:[Long-term results following 131I treatment of thyrotoxic heart disease: a report of 68 cases]. 869 23

Untreated hyperthyroidism during pregnancy is associated with a high incidence of maternal and fetal complications. The perinatal nurse needs knowledge of the pathophysiology of this condition to implement a care plan. Antithyroid medications are used to restore the patient's normal thyroid function. Ongoing evaluation of clinical and laboratory data assists the nurse in recognizing the development and implementation of interventions for complications, such as thyroid crisis and heart failure, in the pregnant patient.
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PMID:Hyperthyroidism during pregnancy: nursing care issues. 879 Dec 26

Cardiovascular changes associated with Graves' disease are generally considered to be secondary to the increased levels of thyroid hormone. We describe a case of Graves' disease in a 25-year-old man, who developed cardiomyopathy with severe heart failure. Pathological examination of the myocardial biopsies showed fibroblast infiltration and degenerative changes. After the cardiomyopathy subsided the patient developed a goitre and signs of hyperthyroidism, followed by Graves' ophthalmopathy, which was treated successfully with a combination of high-dose corticosteroids and orbital radiotherapy. These findings suggested a common pathogenesis for the cardiomyopathy and ophthalmopathy, and prompted us to investigate the expression of TSH receptor (TSH-R) in human heart. TSH-R mRNA was identified in human heart using the reverse transcriptasepolymerase chain reaction (RT-PCR) and DNA sequencing. Taken together, these data suggest that autoimmunity against the TSH-R might contribute to both the cardiomyopathy and ophthalmopathy in similar cases of Graves' disease.
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PMID:Cardiomyopathy associated with Graves' disease. 879 47


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