Thyroid and parathyroid disease
Catherine Nelson-Piercy in Handbook of Obstetric Medicine, 2020
The most discriminatory features in pregnancy are weight loss, tremor, a persistent tachycardia, lid lag and exophthalmos. The latter feature indicates thyroid disease at some time rather than active thyrotoxicosis. Thyrotoxicosis may lead to sinus tachycardia, supraventricular tachycardia or atrial fibrillation. If poorly controlled, a thyroid crisis (storm) in the mother and heart failure may develop, particularly at the time of delivery. Carbimazole and propylthiouracil are the most commonly used anti-thyroid drugs in the United Kingdom. Most patients are initially treated with 15–40 mg carbimazole (150–400 mg PTU) for 4—6 weeks. Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease, although it usually presents after the childbearing years. Untreated hypocalcaemia in the mother increases the risk of second-trimester miscarriage, fetal hypocalcaemia and secondary hyperparathyroidism, bone demineralization and neonatal rickets. Vitamin D deficiency is common in non-Caucasian ethnic groups in the United Kingdom.
The Phenomenon of Adaptive Stabilization of Structures and Heart Protection
Felix Z. Meerson in Adaptive Protection of The Heart: Protecting Against Stress and Ischemic Damage, 2019
The question in what measure the adaptational protection of the heart is due to changes in neurohormonal regulation and in what measure to changes in the heart muscle cells has remained open until quite. When the isolated heart is perfused with toxic doses of epinephrine, there evolves sinus tachycardia with marked impairment of contractility as well as rhythm disorders such as numerous extrasystoles and atrioventricular block. In the aggregate the data provide convincing evidence for the greater capacity of the membrane mechanisms of calcium homeostasis in the adapted hearts with regard to abolishing such detrimental effects of excess calcium as contracture and arrhythmia. Since in combined action of high calcium and imposed contraction rate the calcium load is mainly created owing to its entry through the sarcolemma, this is real evidence for the adaptively enhanced ability of the cardiomyocytes to maintain the rest potential in calcium overload that may be caused by different mechanisms.
Case 12
Edward Schwarz, Tomos Richards in Cases of a Hollywood Doctor, 2019
Phileus Fogg, an English gentleman, presents to your emergency department complaining of shortness of breath. He also complains of some pain on breathing in deeply but thinks he probably pulled a muscle with heavy lifting. He is normally fit and well with no systemic symptoms. He occasionally smokes a pipe. He also reports having recently got back from a ‘round the world trip’ that took him 80 days. This involved long periods of travelling in cramped conditions, including a long trip on a paddle steamer. On examination, his BP is 125/70, heart rate is 125 and regular and his oxygen saturations are 93% on air. He is afebrile and you notice that his left leg is swollen and warm, but Mr Fogg says, ‘don’t worry about that, it is probably from a bite or something.’ A chest radiograph is unremarkable and an ECG shows a sinus tachycardia.
Sinus tachycardia: don’t blame the whistle-blower
Published in Acta Cardiologica, 2013
Michel De Pauw, Fiona Tromp, Marc De Buyzere
Unstructured abstract Sinus tachycardia due to sympathetic activation may be the ultimate response to support cardiac output. Abrupt heart rate reduction in this condition may be deleterious as is illustrated by two cases. Both patients were referred in cardiogenic shock after inappropriate treatment with a beta-blocking agent, initiated as a symptomatic treatment of a sinus tachycardia. Thus even if beta-blocking agents provoked a paradigm shift in the understanding of heart failure and became a cornerstone of the treatment, therapy should be initiated with knowledge of the underlying condition.
The use of ivabradine for inappropriate sinus tachycardia
Published in Acta Cardiologica, 2011
Tim Weyn, Dirk Stockman, Yves Degreef
We present a 47- year-old woman with inappropriate sinus tachycardia. Initial treatment with beta blockers was not successful. The patient became asymptomatic and tachycardia resolved with ivabradine. In this report we review the potential role of ivabradine in the treatment of inappropriate sinus tachycardia.
An unusual cause of cardiothyreosis
Published in Gynecological Endocrinology, 2016
Lucien Marchand, Paul Chabert, Elise Chaudesaygues, Mélanie Grasse, Stephan Bretones, Julia Graeppi-Dulac, Jean-François Aupetit
Severe hyperthyroidism can cause cardiac complications, such as severe rhythm disturbances, heart failure and angina. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from benign hydatidiform mole to malignant form. Clinical hyperthyroidism may occur in GTD, as human chorionic gonadotropin (hCG) secreted by molar tissue is structurally similar to thyroid-stimulating hormone. Cardiothyreosis in this context is exceptional. We report the case of a nulligravida 42-year-old woman without thyroid or cardiac history who presented to the emergency department for dyspnoea. Examinations revealed an acute pulmonary oedema and sinus tachycardia. Serum hCG concentration was abnormally high (762 878 UI/l, N
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