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

A series of 51 cases of thyrotoxicosis gathered during a period of 6 years in a department with a cardiological orientation is analysed. This peculiar form of thyrotoxicosis is often unrecognized in view of its frequent occurence in aged subjects (which is misdiagnosed as "senile heart") and of the incidence in its causality of a toxic adenoma, the endocrine semiology of which is often reduced. In front of any case of heart failure of unknown cause, one should systematically think of a thyroid aetiology. A persistent sinus rhythm is not enough to discard it. A low cholesterol rate should induce to continue the investigation. The subnormal character of the classical laboratory parameters (including the thyroid hormone assay) does not always make it possible to exclude definitely the diagnosis. When the clinical picture is suggestive, only the radio-isotope examination with dynamic tests is liable to provide decisive data.
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PMID:[Clinical considerations apropos of 51 cases of cardiothyrotoxicosis]. 81 8

More than 200 years ago, Caleb Parry described cardiological manifestations of hyperthyroidism. Interaction of thyroid hormones and sympathoadrenal system (responsible for rhythm disorders) and direct effect of thyroid hormones on the cardiac muscle (responsible for occurrence of hypertrophy and cardiac insufficiency) have been recognized as the pathophysiological basis of cardiovascular disorders of patients with hyperthyroidism. The aim of the study was to retrospectively analyze surgically treated patients with different types of hyperthyreosis, and establish the incidence and clinical significance of the left ventricular dysfunction related to duration and treatment of hyperthyreosis. Evaluation of left ventricular function was based on the ejection fraction during exercise. Signs of hypertrophy were echocardiographically, radiographically and electrocardiographicaly recorded. Over the period 1993-1997 at the Surgical Department of the institute of Endocrinology in Belgrade 423 patients with hyperthyreosis were operated: 293 (69.26%) patients had Graves-Basedow's disease, 74 (17.49%) toxic adenoma, and 58 (13.28%) toxic polynodal struma. The average duration of the disease in patients with Graves-Basedow's hyperthyreosis was 5 yrs, and the average age of patients was 29 yrs; the average duration of hyperthyreosis in patients with toxic adenoma was 1.2 yrs, and in cases of toxic polynodal struma 17 yrs. Pathological response of ejection fraction during exercise was recorded in 60% of patients. Signs of hypertrophy of the left chamber were recorded in 17% of subjects, and insufficiency of the left chamber with congestive stasis in the lungs in 4.6% of patients. The most common ECG changes were: synus tachycardia, higher voltage of P and T waves, elevated amplitude of QRS complex, prolonged P-Q and shortened Q-T intervals. In 20% of cases atrial fibrillation was evidenced. One patient had ECG signs of myocardial infarction. Clinical features of left ventricular dysfunction in hyperthyroidism include: occurrence in younger patients with history of hyperthyroidism, progressive course and occurrence of congestive cardiac failure as well as reversible nature of all cardiac changes after radical therapy of hyperthyreosis which can be medical, surgical or irradiation.
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PMID:[Cardiovascular manifestations of hyperthyroidism. Clinical significance and preoperative preparation]. 1133 17

In the treatment of the thyrotoxic heart a radical, early thyroeliminating procedure should have preference. As the method of first choice a single administration of a whole calculated dose of I131 is recommended without previous medicamentous preparation up to 25-30 mCie which can be administered also in the out-patient department, with subsequent immediate treatment with thyrostatics and beta-blockers till remission of thyrotoxicosis is achieved (6-12 weeks). Total strumectomy after medicamentous preparation in remission of thyrotoxicosis is preferred in large multinodular, iodinated patients and in solitary toxic adenoma where however also partial STE (lobectomy) is possible and radioiodine is equivalent. Its dosage in toxic adenoma and nodular goitre is however in general higher than in diffuse goitre but the incidence of late postadministration hypothyroidism is lower. Fibrillation arrhythmia usually (in ca 60%) recedes spontaneously with the assistance of beta-blockers in remission of thyrotoxicosis. If this does not occur, pharmacological or electric cardioversion is necessary after anticoagulation preparation, because persistence of FA is an important risk factor of cardiac failure and thromboembolic complications. Eurhythmia then usually lasts as long as remission of thyrotoxicosis persists or there is no overdosage of substitution doses of T4 during treatment of hypothyroidism which develops after thyroelimination treatment. Amiodarone is unsuitable, even contraindicated, for treatment of fibrillation arrhythmia in thyrotoxic heart.
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PMID:[Thyrotoxic heart disease. Part II--aspects of treatment of thyrotoxicosis with cardiac involvement]. 1194 22

Thyrotoxicosis is underdiagnosed because of its low occurrence in series from Africa. The aim of this study was to evaluate the frequency, the demographic data, and the etiological aspects of thyrotoxicosis among hyperthyroidy. Thirty-six patients with thyrotoxicosis (group I) gathered during a period of four years was analysed, as well as 180 hyperthyroidy cases (group II). Cardiothyrotoxicosis was observed with a frequency of 16.6%. The mean age was respectively of 44.5+/-13.3 versus 32.8+/-11.4 years (p<10(-6)). Cardiothyrotoxicosis was related to multinodular goitres (18 cases), a Basedow disease (14 cases), a toxic adenoma (four cases), while the principal cause of hyperthyroidy was toxic adenoma followed by the Basedow disease (72 cases, 40%). Different modes of presentation of cardiothyrotoxicosis were found: cardiac heart failure in 27 cases (75%), permanent atrial fibrillation in 22 cases (61.1%), atrial flutter in two cases, coronary insufficiency in four cases, ventricular extrasystoli (trigeminism) in two cases, second auriculoventricular block in two cases, dilated myocardiopathy in 10 cases (27.7%), ischemic myocardiopathy in four cases, severe mitral regurgitation in one case. This study confirms the relative frequency of cardiothyrotoxicosis, the proportionally weak place of Basedow disease among hyperthyroidy's causes, and role of associated cardiac disease to the hyperthyroid.
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PMID:[Cardiothyrotoxicosis in the young adult in Marrakech. A report of 36 cases]. 1893 25