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

Unexplained cardiomegaly with cardiac failure was observed in a 42-year-old woman in whom a pituitary tumour had been treated by radiotherapy five years previously. She had been amenorrhoeic for 10 years. Thyroid and adrenal function was normal. Despite treatment with digitalis and diuretic, her cardiac disease progressed until she died suddenly at the age of 45. Hyperprolactinaemia was evident some weeks before death, her serum concentration of 68 ng/ml being well above both the reported normal range (2--20 ng/ml) and the concentrations in eight female controls being treated for severe cardiac failure (5--25 ng/ml). Although the association of these two disorders might merely represent coincidence, heart disease with similar features is common in acromegaly and does not correlate with plasma growth hormone concentration. Since prolactin is known to exert metabolic growth hormone-like effects in animals and in man, the possibility should be considered that prolactin hypersecretion might induce or maintain cardiac disease in some patients with pituitary tumours. A preliminary survey of 35 subjects with hyperprolactinaemia has shown five with raised blood pressure and four, two of whom were normotensive, with cardiomegaly on chest radiography.
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PMID:Cardiomegaly and heart failure in a patient with prolactin-secreting pituitary tumour. 15 31

Reduced left ventricular function and other factors, such as vascular resistances, redistribution of cardiac output and impaired muscular metabolism, limit exercise performance in chronic heart failure. Thyroid hormones have a positive cardiac inotropic effect, stimulate protein synthesis (particularly at muscular level) and reduce peripheral vascular resistances with consequent increase of cardiac output. Therefore, it is possible that thyroid hormones can improve exercise performance in chronic heart failure. We have administered L-thyroxin (100 mcg/die) for 1 week to 9 patients affected by primary dilated cardiomyopathy. All the patients were euthyroid (T3 = 1.06 +/- 0.1 mcg/ml, T4 = 8.5 +/- 1.9 mcg/dl, TSH = 1.32 +/- 0.7 mU/ml) and in II-III NYHA functional class. Before starting the treatment and at the end of it, we performed the cardiopulmonary exercise test and the echocardiogram. We also evaluated the resting hemodynamic parameters through catheterization and the plasmatic values of thyroid hormones and noradrenaline. At the end of the treatment all patients were euthyroid, despite a significant (p less than 0.05) increase of T4 (10.5 +/- 3.2 mcg/dl) and a decrease of TSH (1.1 +/- 0.1 mU/ml). Mean values of effort parameters changed as follows: peak oxygen consumption from 19.6 +/- 1.6 to 20.6 +/- 1.3 ml/min/kg, tolerance time from 460 +/- 61 to 481 +/- 60 s. These variations were not associated with changes in resting hemodynamic parameters and noradrenaline. Left ventricular ejection fraction, calculated by echocardiography, increased from 26 +/- 6 to 28.9 +/- 8% (p less than 0.05). We conclude that in dilated cardiomyopathy short term treatment with L-thyroxin significantly improves patient's response to cardiopulmonary exercise test.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The improvement in physical exercise capacity in dilated cardiomyopathy during short-term treatment with L-thyroxine]. 158 20

Thyroid function was studied in 40 patients with chronic heart failure. Thyroid antibodies and microsome antibodies were negative in all cases. Serum T4, and T3 concentrations showed significant inverse correlation with cardiothoracic ratio, mean right atrial pressure, pulmonary artery systolic pressure, and peripheral venous pressure. Serum T4, T3 concentrations showed significant correlation with PaO2, serum albumin, and serum cholinesterase. Serum TSH concentrations increased with increasing cardiothoracic ratio. Histological examinations showed fibrosis and atrophy of the thyroid gland in 2 cases. These findings suggest the possible development of primary hypothyroidism as a result of chronic heart failure.
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PMID:Primary hypothyroidism in severe chronic heart failure. 296 70

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

To determine the outcomes of percutaneous transluminal angioplasty (PTCA) in patients with subclinical hypothyroidism and to compare them with those in euthyroid patients, we studied retrospectively 48 hypothyroid (4 overtly and 44 subclinically hypothyroid) and 122 euthyroid patients who had a PTCA in Boston's Beth Israel Hospital between 1984 and 1994. No significant differences were detected in bradycardia (relative risk, RR: 0.96), tachyarrhythmia (RR: 0.62), heart failure (RR: 2.27), hypotension (RR: 1.95), or bleeding (RR: 2.48) in the immediate postprocedure period between euthyroid and subclinically hypothyroid patients. There was a trend towards an increased incidence of chest pain (43.2 vs 27.5%, RR: 1.57, p = 0.084), dissection (50 vs 33%, RR: 1.51, p = 0.06) as an immediate, and reocclusion as an early (within 2 weeks) postprocedure complication (6.25 vs .9%, RR: 6.81, p = 0.08). However, chest pain accompanied by electrocardiographic changes was not significantly different between the two groups (20.5 vs 14.7%, RR: 1.4, p = 0.47). There was no difference in the number of procedures rated as successful (subclinically hypothyroid vs euthyroid: 90.2 vs 92.7%). Hospital charges, discharge destination, interval to next admission to the hospital, and in-hospital mortality were not different between the two groups. Subclinical hypothyroidism does not appear to be a risk factor for significant morbidity or increased mortality following PTCA. Prospective long-term studies with increased statistical power are needed to clarify whether there is an association between hypothyroidism and complications (especially chest pain, dissection, and/or reocclussion) in the early (2 weeks) and late (6 months) post-PTCA period.
Thyroid 1995 Oct
PMID:Outcome of percutaneous transluminal coronary angioplasty in patients with subclinical hypothyroidism. 856 77

A case of a pregnant woman who underwent urgent cesarean section is presented. The patient had severe hyperthyroidism, preeclampsia, and congestive heart failure, which had not been treated until 36 weeks of gestational age. At 38 weeks, fetal distress occurred and an urgent cesarean section was performed successfully under epidural anesthesia with preoperative treatments using iodide, hydrocortisone and propylthiouracil. The patient required postoperative intensive care for heart failure. Thyroid function of the neonate was almost normal. No abnormality was observed except low birth weight.
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PMID:[Cesarean section in a patient with uncontrolled hyperthyroidism, preeclampsia, and congestive heart failure]. 886 14

Though thyroid hormone abnormalities have been identified in many cardiac conditions, the role of thyroid hormones in congestive heart failure has not been well defined. In a population of patients with advanced heart failure, a reduction in triiodothyronine (T3) with an increase in reverse T3 was identified in many patients, with an abnormally low ratio of T3/reverse T3 being the strongest predictor of mortality. Normalization of thyroid indices appeared to be necessary for prolonged survival to occur. To address the concern of T3 administration possibility exacerbating a hypermetabolic state, basal metabolic rate was measured in a group of advanced heart failure patients and was found to be generally within the normal range. A preliminary safety study of short-term intravenous T3 administration (bolus +/- 6 h infusion, total dose 0.15-2.7 micrograms/kg) was then performed in 23 patients under hemodynamic and electrocardiographic monitoring. There were neither adverse events nor substantial hemodynamic changes, but some patients had an increase in cardiac output, consistent with a peripheral vasodilatory effect. With this foundation, further investigation into the possible role of T3 and its analogs in congestive heart failure therapy may be pursued.
Thyroid 1996 Oct
PMID:Thyroid hormone abnormalities in heart failure: possibilities for therapy. 893 83

The possibility that thyroid hormone or a thyroid hormone analogue that improves cardiac performance might be useful in the treatment of heart failure has-been examined. In the rat postinfarction model of heart failure, treatment with low doses (1.5 micrograms/100 g) of thyroxine (T4) for 3 days produced a positive inotropic response, including an increase in left ventricular (LV) dP/dt and a decrease in LV end-diastolic pressure (LVEDP). When treatment with T4 was continued at the same or higher doses (3 to 15 micrograms/100 g) for 10-12 days, heart rate was increased and improvement in LVEDP was not sustained. To identify an analogue with a more favorable hemodynamic profile, single- and double-ring compounds related to T4 were screened for thyromimetic activity in heart cell cultures and for their ability to bind thyroid hormone receptors. One of the analogues selected, 3,5-diiodothyropropionic acid (DITPA), was found to have inotropic selectivity in hypothyroid rats. When administered (375 micrograms/100 g) to rats with ventricular dysfunction after myocardial infarction in combination with captopril, there was improvement of the resting and stressed cardiac index and LV filling pressure. Similar improvement in cardiac performance was obtained when DITPA was administered to rabbits after infarction. Thus a thyroid hormone analogue with inotropic selectivity may be a useful adjunct to other measures in the treatment of heart failure.
Thyroid 1996 Oct
PMID:Development of a thyroid hormone analogue for the treatment of congestive heart failure. 893 82

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation (AF) may dominate the clinical picture and mask the more classic endocrine manifestations of the disease. Impaired cardiopulmonary function and exercise capacity, significantly more marked in older patients, is observed in hyperthyroidism. Thyrotoxicosis can aggravate pre-existing heart disease and can also lead to AF, congestive heart failure, or worsening of angina pectoris. Regarding the high incidence of AF in older patients with hyperthyroidism, it is also important to detect subclinical hyperthyroidism in older patients with AF, thus warranting the measurement of the serum thyrotropin (TSH) concentration for early recognition and treatment. Most cardiac abnormalities return to normal once a euthyroid state has been achieved, although AF may persist in a minority. Optimal treatment requires rapid and definitive antithyroid therapy. Furthermore, anticoagulation is recommended for thyrotoxic patients with AF older than 50 years, those who have histories of previous emboli, hypertension, or with echocardiographic evidence of left atrial enlargement and/or myxomatous valves.
Thyroid 1998 Dec
PMID:Cardiac risks of hyperthyroidism in the elderly. 992 Mar 73

Iodine-induced thyrotoxicosis or "jodbasedow phenomenon" has been reported throughout the world since iodine has been administered to treat endemic goitre. Nowadays, iodinated radiocontrast agents and the antiarrhythmic drug amiodarone are the most common sources of excess iodine load subsequently leading to iodine-induced thyrotoxicosis, especially in elderly patients with underlying goitre. The aim of the study was to identify the number of cases of iodine-induced thyrotoxicosis among patients with thyrotoxicosis in a large urban hospital. Over an 18-month period thyrotoxicosis has been diagnosed in a total of 39 patients. Eight patients with iodine-induced thyrotoxicosis (5 female, 3 male; mean age 60.6 years) have been identified (20%). In all patients with iodine-induced thyrotoxicosis, iodine exposure with a mean iodine dose of 21.5 g was documented 2 to 16 weeks before diagnosis (iodinated radiocontrast agents in 5 patients, amiodarone in 2 patients, kelp tablets in 1 patient). Clinical features were predominantly tachyarrhythmias and heart failure, while 6 of 8 patients had goitre (thyroid volume 31 to 193 ml). Thyroid antibodies were not detected. Diagnosis was confirmed in 5 of 8 patients with increased urinary iodine concentrations (3436 to > 6000 nmol/24 h), and in 3 of 8 patients with a low tracer uptake in thyroid scintigraphy (1 to 4%). Treatment consisted of methimazole in all patients, additional tional beta-blockers and lithium in 4 patients, and prednisone in 5 patients. The mean treatment ment duration was 9.2 months, and patients became euthyroid after a mean treatment duration of 6.4 weeks. One patient (with still elevated free thyroxine levels) died of myocardial infarction 4 weeks after antithyroid drug therapy had been installed. The incidence, mechanisms and features of iodine-induced thyrotoxicosis are discussed. Iodine-induced thyrotoxicosis is a common disease, and the recognition and treatment of iodine-induced thyrotoxicosis, particularly in elderly patients and patients with goitre, are of clinical importance.
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PMID:[Iodine-induced hyperthyroidism (iodine-induced Basedow's disease): a current disease picture]. 1040 36


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