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

Hyperthyroidism is reportedly uncommon in the indigenous populations of Africa. The presenting symptoms volunteered, the symptoms elicited by direct questioning, and the results of physical examination were therefore prospectively compared in 60 Black and 56 White patients with thyrotoxicosis attending a single thyroid clinic. Fewer Blacks than Whites volunteered information about weight loss, while more Blacks complained only of the presence of a goitre. A 'change' diagnosis of hyperthyroidism was made more frequently in Blacks. Symptomatology elicited by direct questioning and findings on physical examination were generally similar in each group, except that Blacks presented more frequently with complicated disease (cardiac failure and overt myopathy) and infiltrative ophthalmopathy. The frequency with which hyperthyroidism presents 'atypically' in Black compared with White patients may reflect educational, socio-economic and Cultural differences in the Black and White populations, and may partly explain the infrequency with which this disease is diagnosed in Blacks.
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PMID:Atypical features of hyperthyroidism in blacks. 740

Thyrotoxic artrial fibrillation is well known and occurs in 10-30% of all patients with thyrotoxicosis. The risk of systemic embolism has been found to be 10-40% in patients with thyrotoxic atrial fibrillation. We present a case of 53 year-old man, a healthy and active athlete, with atrial fibrillation and thyrotoxicosis. He was treated with a beta-blocking agent (sotalol) and sent home. Seven days later, he suffered systemic arterial emboli, one in the right arm and one in the left leg. After embolectomy the patient started anticoagulation and no further complications occurred. Previous studies are discussed, and the following conclusions made. When taken together the data suggest that the rate of embolism in patients with thyrotoxic atrial fibrillation exceeds that of non-thyrotoxic atrial fibrillation unassociated with rheumatic heart disease. The majority of clinically evident embolic events that occur in patients with thyrotoxic atrial fibrillation involve the central nervous system. The rate of embolic events appears to be greatest early in the course of thyrotoxic atrial fibrillation, but may persist for some weeks after conversion and may be particularly high in patients with associated heart failure. It is suggested that anticoagulation therapy should be considered in these patients.
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PMID:[Embolic episodes after treatment of atrial fibrillation in a patient with thyrotoxicosis]. 765 95

The authors describe the clinical characteristics and response to therapy of seven patients with hyperthyroidism, dilated cardiomyopathy, and low-output cardiac failure. All patients (4 women and 3 men, age 47 +/- 4 years, mean +/- standard error of the mean) were admitted with the primary diagnosis of congestive heart failure. The cause of hyperthyroidism was Graves' disease in six patients, and toxic multinodular goiter in one. On admission, the mean serum T4 was 21 +/- 1 microgram/dL and mean serum T3:411 +/- 77 ng/mL, and serum thyroid-stimulating hormone was suppressed ( < 0.03 microU/mL) in all patients. Two-dimensional echocardiogram showed biventricular or four chamber dilatation and impaired left ventricular performance. Therapy of heart failure and hyperthyroidism resulted in rapid clinical improvement. During follow-up (5 months to 9 years), left ventricular ejection fraction improved from a mean of 28% to a mean ejection fraction of 55% (P < 0.01). Resolution of dilated cardiomyopathy with normalization of systolic function was achieved in five patients, and improvement from severe to mild left ventricular dysfunction was observed in two patients. We conclude that some patients with hyperthyroidism may have a reversible form of dilated cardiomyopathy and "low-output failure." Assessment of thyroid hormone status in patients with heart failure might permit the identification of patients with dilated cardiomyopathy and thyrotoxicosis who are likely to have reversible cardia dysfunction.
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PMID:Congestive heart failure due to reversible cardiomyopathy in patients with hyperthyroidism. 766 12

Despite cardiac failure being a well recognised complication of thyrotoxicosis, systolic function has generally been reported as maintained or enhanced. In this study, left ventricular diastolic function was assessed in 16 thyrotoxic patients and 18 age-matched controls by pulsed-Doppler echocardiography. Patients were re-studied after 3 and 12 months of treatment. Prior to treatment all standard Doppler-derived indices of diastolic function were significantly different to control (isovolumic relaxation time (IVRT) 63 +/- 18.9 vs 84.0 +/- 14.8 ms, peak early filling velocity (Emax) 79.2 +/- 15.2 vs 61.9 +/- 10.7 cm.s-1, peak atrial filling velocity (Amax) 68.2 +/- 17.9 vs 42.2 +/- 9.4 cm.s-1, deceleration of early filling (E/F slope) 6.1 +/- 1.8 vs 3.7 +/- 1.1 m.s-1, thyrotoxic vs control). However, these filling abnormalities appear likely to reflect the tachycardia and reduced systemic vascular resistance (SVR) found in the patients (heart rate 102 +/- 15 vs 76 +/- 9, SVR 874 +/- 207 vs 1293 +/- 362 dynes.s-1 x cm-5, both P < 0.001). After 3 months of treatment haemodynamics were similar in the two groups but filling remained abnormal in patients with a pattern suggesting increased transmitral pressure gradients (Emax 73.1 +/- 15.1 cm.s-1, Amax 55.8 +/- 19.2 cm.s-1, E/F slope 4.9 +/- 2.0 m.s-1, all P < 0.05 compared to controls).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricle filling abnormalities prior to and following treatment of thyrotoxicosis--is diastolic dysfunction implicated in thyrotoxic cardiomyopathy? 768 85

Two hundred and ninety one patients admitted with atrial fibrillation through the emergency room of a regional hospital in the year 1993 were reviewed to evaluate the presenting features and in-hospital treatment of patients with symptomatic atrial fibrillation. The incidence of atrial fibrillation increased with age (mean age was 73 +/- 12 years) and the ratio of female to male was 1.8:1. The commonest presenting features were palpitation (42.3%), dyspnoea (38.1%) and heart failure (16.4%). The most frequently associated cardiac conditions were hypertension (28.9%), atherosclerotic cardiovascular disease (24.7%) and rheumatic heart disease (17.5%). Pulmonary diseases (18.6%), diabetes mellitus (12.7%) and thyrotoxicosis (6.2%) were the principal associated non-cardiac conditions. Thromboembolic complications were found in 15 patients at presentation (5.2%). Cardiac enzyme assessment was investigated in two thirds of the patients (68.1%), while thyroid function test (59.5%) and echocardiography (29.6%) were less commonly investigated. Digoxin was still the most popular drug used for ventricular rate control, and cardioversion was performed in only 6.9% of patients. Antithrombotic therapy was used in 5.8% of patients only although it was clinically indicated in more than half of the patients (52%). Contraindications of anticoagulation were found in 23 patients (7.9%), including a history of gastrointestinal or cerebrovascular bleeding, active bleeding, chronic renal failure and poor drug compliance. The mean hospital stay was 5 +/- 4 days, compared to a mean stay of 2.7 days for other medical patients. Fourteen patients (4.8%) died during hospitalisation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital. 778 42

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

Graves' disease, which is an organ-specific autoimmune disorder, is the most frequent cause of thyrotoxicosis. Females are more often affected than males. The clinical pattern varies, however, and nearly every organ system may be involved. This case study describes a formerly healthy young woman with Graves' disease who was admitted to the hospital with cardiac failure, convulsions and generalized lymphoid hyperplasia. A reversible thyrotoxic cardiomyopathia combined with hyperdynamic circulation may result in cardiac failure even in younger patients, and the cardiac function normalizes in the euthyroid state. Seizures may occur in association with hyperthyroidism. High doses of propranolol may precipitate the condition by lowering the threshold for seizures.
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PMID:[Heart failure and convulsions in thyrotoxicosis. A young woman with Graves' disease]. 797 5

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

We report 4 adult patients with thyrotoxicosis accompanied by irreversible low-output heart failure. Each patient showed elevated plasma levels of thyroid hormone and prolonged low-output heart failure even after thyroid function returned to normal. Specimens of the right ventricular myocardium stained with anti-beta myosin heavy-chain MAb showed a normal staining pattern with a predominance of the beta-form. Our observations suggest that thyrotoxicosis may be one possible cause of irreversible cardiomyopathy.
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PMID:Irreversible cardiomyopathy due to thyrotoxicosis. 818 12

Presented is a case story of a patient with highly elevated serum levels of the tumour marker CA 125 (Cancer Antigen 125). The patient was thought to have ovarian cancer, but eventually the source of the elevated serum CA 125 levels became clear: cardiac failure caused by thyrotoxicosis. Benign and malignant causes of elevated serum levels of CA 125 are described briefly.
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PMID:Highly elevated serum CA 125 levels in a patient with cardiac failure. 844 65


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