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

Rapid and intense thyroxine substitution can lead to heart failure and myocardial infarction in hypothyroid patients. We have analyzed the normalization of the circulatory system in hypothyroid subjects on a gradual thyroxine substitution. Fourteen hypothyroid patients were studied repeatedly with an orthostatic test and a standardized symptom-limited exercise test during substitution. ST and T abnormalities were observed in 51 and 33%, respectively, before substitution. Many of these changes were normalized upon substitution at a dose level of 0.15 mg/d thyroxine. The pulse reaction to standing was enhanced early during substitution. The capacity to perform work, on the other hand, responded more slowly to thyroxine substitution, and was significantly increased only after six months of full substitution. This difference in the time course of recovery may be of clinical importance when substituting patients with hypothyroidism and ischemic heart disease.
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PMID:The cardiovascular response at rest and during exercise in hypothyroid subjects to thyroxine substitution. 685 Dec 72

Evaluation of pericardial effusion was attempted with computed tomography in 11 patients. The volume and distribution of pericardial fluid were assessed with satisfactory resolution and the nature of the fluid was estimated by the difference in x-ray transparency (CT numbers). The volume of pericardial fluid calculated by tomographic methods ranged from 25 ml. to 585 ml. and agreed well with the surgically drained fluid volume. The CT numbers of the pericardial effusion due to renal or heart failure, acute viral pericarditis, hypothyroidism, and hemopericardium were +12 to +13, +20, +28 to +30, and +26 to +40, respectively. Therefore the volume and gross nature of the pericardial fluid could be estimated noninvasively with computed tomography.
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PMID:Evaluation of pericardial effusion with computed tomography. 737 90

The two isomers of the positive inotropic compound EMD 53998, (+)EMD 57033 and (-)EMD 57439, possess selective calcium sensitizing and phosphodiesterase (PDE) inhibitory properties, respectively. We measured the pharmacological responses to both enantiomers in isolated rat cardiac and vascular tissues and in muscles from severely failing human hearts. We also measured positive inotropic and chronotropic responses to EMD 57033 in cardiac tissues from rats with thyroid dysfunction, diabetes, or hypertension. Both compounds increased force of contraction in isolated rat cardiac tissues, although the ventricular response to EMD 57439 was only approximately 10% that of calcium chloride. Forskolin pretreatment potentiated responses to both compounds in atria but only to EMD 57439 in ventricles. Hyperthyroidism increased ventricular responses to EMD 57033 relative to calcium chloride; hypothyroidism and diabetes decreased these responses. Ventricular responses were unchanged in hypertensive rats. Both enantiomers produced positive inotropy in human isolated right atrial trabeculae, although the maximal increases were only 14% (EMD 57033) and 26% (EMD 57439) that of calcium chloride. In rat thoracic aortic rings, both enantiomers produced relaxation; the responses due to EMD 57033 were endothelium dependent. Thus, calcium sensitization produces positive inotropy and vascular relaxation in rats. Positive chronotropic responses to EMD 57033 are most likely due to PDE inhibition. The limited inotropic response in severely failing human myocardium, together with possible vasorelaxation, may provide cardiac support in heart failure without an excessive increase in cardiac O2 demand.
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PMID:Calcium sensitization as a positive inotropic mechanism in diseased rat and human heart. 752 44

Serum concentrations of triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH) were measured in 127 patients with chronic heart failure (CHF) (left ventricular ejection fraction; 40% < or = and NYHA; III-IV), and 1,079 patients without CHF (non-CHF) (left ventricular ejection fraction; 40% < or = and NYHA; I-II). Serum-T3, T4 and free-T4 were significantly decreased in patients with CHF. The prevalence of slight increase of serum TSH (5 < or = TSH < 15 microU/ml) were 20.5% in CHF and 4.08% in non-CHF. There was a statistically significant difference in the prevalence of slight increase of TSH (p < 0.01). In the patients with slight increase of serum TSH, the 123I-thyroid scintigraphy and perchlorate test were performed 12 patients with CHF and 19 patients with non-CHF. The incidences of iodine organification defect were 33.3% in CHF and 5.26% in non-CHF. There was a statistically significant difference in the incidence of iodine organification defect (p < 0.05). The histologic examination of thyroid biopsy specimen obtained 12 patients with CHF and primary hypothyroidism, these revealed only non-specific mild atrophic changes. Follicular damage and lymphocyte-infiltration were not evident. These findings suggest that the primary hypothyroidism were frequently complicated in CHF and associated with iodine organification defect by reduction of thyroid-peroxidase activity or decrease of hydrogen peroxidase. We conclude that the primary hypothyroidism with iodine organification defect was probably developed as a result of CHF.
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PMID:[Thyroid hormones and thyroid-stimulating hormone in patients with chronic heart failure--relationship between primary hypothyroidism with iodine organification defect and chronic heart failure]. 773 54

To accurately evaluate thyroid disorders in pregnancy, the physician must understand the physiologic changes that occur both in thyroid gland size and in thyroid function tests. The effect of thyrotoxicosis on pregnancy outcome largely depends on whether metabolic control is achieved. Women who become euthyroid on treatment usually can expect satisfactory outcomes. Propylthiouracil is considered to be the drug of choice for treating thyrotoxicosis during pregnancy. Because of the significant risk of hypothyroidism and obvious goiter in the infant, the use of iodide should be reserved for severe disease, such as thyroid storm or heart failure. Thyrotoxic infants may need antithyroid treatment until TSAbs are metabolized. Since overt hypothyroidism is often associated with infertility, it is uncommon in pregnancy. Hypothyroid women who do become pregnant, however, have an increased risk of low-birth-weight or stillborn infants. These women may require a greater dosage of thyroid hormone during pregnancy. The effects of subclinical hypothyroidism are not well defined. Accordingly, the need for treatment hinges on the woman's clinical history. Infants of hypothyroid mothers usually show no evidence of thyroid dysfunction, but those who are hypothyroid should receive prompt thyroid replacement therapy. To minimize the sequelae of congenital hypothyroidism, mass screening of infants and prompt treatment of those affected is recommended. During pregnancy, thyroid nodules should be evaluated by ultrasound and fine-needle aspiration or tissue biopsy. Radioiodine scanning should be avoided during pregnancy. If thyroid cancer is diagnosed, pregnancy should not delay treatment. Because postpartum thyroid dysfunction is fairly common yet difficult to detect, physicians and patients should be aware of the symptoms and risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Thyroid disease in pregnancy. ACOG Technical Bulletin Number 181--June 1993. 790 64

Thyroid disease is common in veterinary practice. The heart, especially the myocardium, is sensitive to thyroid hormone, and deficiencies or excesses can alter cardiovascular function. Observed changes result from direct effects upon the myocardium and indirect effects that result from effects upon the vasculature and peripheral tissues. Clinically significant cardiovascular abnormalities related to hypothyroidism are rare. If present, they are primarily manifest as reduced left ventricular pump function, as apparent echocardiographically, or arrhythmias. Hyperthyroidism is common in the cat and infrequently encountered in dogs. Clinically significant cardiovascular manifestations are common and often dramatic. Hyperdynamic systolic function and mild myocardial hypertrophy are common manifestations which may lead to overt congestive and high output heart failure. If signs of congestive heart failure or significant arrhythmias are not evident, specific therapy need only be directed toward restoration of the euthyroid state. In most cases the cardiovascular changes associated with thyroid dysfunction are completely reversible.
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PMID:Effects of thyroid hormone and thyroid dysfunction on the cardiovascular system. 805 9

A total of 187 patients with coronary heart disease (CHD) were examined. Out of them 60% were found as having subclinical hypothyroidism. The serum levels of T3 were significantly lower, particularly in arrhythmic CHD, the level of T4 was normal and even increased, thus making the concentrations of TTG normal, i.e. the T3-low-syndrome was detected. Hypothyroidism in CHD patients decreased tissue oxygen consumption, by reducing the incidence of acute myocardial infarction, heart failure, the atherosclerotic process becoming disseminated and progressive. Cordarone therapy was found to promote the progression of T3-hypothyroidism, i.e. in CHD patients with suspected hypothyroidism, the drugs inhibiting the thyroidal function should not be used. T3-Hypothyroidism should be corrected with adequate doses of triiodothyronine in CHD patients. The use of thyroxine is ineffective as the conversion of T4 to T3 is impaired in the body.
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PMID:[Subclinical hypothyroidism in patients with ischemic heart disease]. 814 23

The common underlying heart diseases were ischemic heart disease (39%), valvular heart disease (27%), hypertensive heart disease (10%) in 104 patients (mean age 79 yrs) with congestive heart failure (CHF). Cardiomyopathy (5%) and congenital heart disease (2%) such as atrial septal defect were less common. In addition, many extracardiac diseases including anemia, hypothyroidism, renal failure and pulmonary disease contributed to the etiology of CHF in the elderly. Cardiac amyloidosis should be considered as an uncommon cause of refractory CHF. While the precipitating factor was not found in half of the 104 patients with CHF, the most common factors were respiratory infection, myocardial ischemia and arrhythmia. In addition, inappropriate drug usage including poor drug compliance, the use of beta-blockers and excessive intake of sodium and fluid precipitated or exacerbated heart failure. Renal failure was a most important complication and predisposed to refractory CHF. Aged patients with mild CHF (NYHA class II) showed an insufficient production of cyclic AMP and GMP in proportion to the increases of norepinephrine and atrial natriuretic peptide in comparison with health aged subjects after the submaximal treadmill exercise test. This finding may suggest that an inadequate compensation of neurohumoral factors is prone to cause CHF in the elderly. Appropriate management of acute CHF in the elderly begins with recognition of the underlying heart disease, complications and the severity of cardiac function. In addition to medical management including loop diuretics, vasodilator, beta-receptor agonist and phosphodiesterase inhibitor, cases associated with respiratory and renal failure require mechanical ventilation and continuous hemofiltration.
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PMID:[The etiology and management of congestive heart failure in the elderly]. 820 67

Hypothyroidism may present with weight gain and/or cardiovascular manifestations such as bradycardia or cardiac failure, but has not previously been documented as presenting with atrial fibrillation and weight loss. Our case highlights the importance of thyroid function tests in heart failure and emphasises the importance of regular follow-up after irradiation to the thyroid.
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PMID:Covert hypothyroidism with weight loss and atrial fibrillation. 829 76

Several endocrine diseases show the symptoms of cardiac failure. Among them, patients with acromegaly show a specific cardiomyopathy which results in a severe left-sided cardiac failure. Hypoparathyroidism also induces cardiac failure, which is resulted from hypocalcemia and low levels of serum parathyroid hormone. In the cases of hypothyroidism, the patients with myxedemal coma show a severe cardiac failure, which is characterized by disturbance of central nervous system, renal function, and cardiac function. In the patients with thyroid crisis (storm), the cardiac failure comes from the great reduction of cardiac output with dehydration. The reduction of circulation volume, observed in the patients with pheochromocytoma easily induces cardiac failure (shock) just after the removal of adrenal tumor. In patients with malignant carcinoid syndrome, right-sided ventricular failure which may be occurred through the actions of biogenic amines is observed.
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PMID:[Cardiac failure in endocrine diseases]. 833 6


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