9甲状腺功能亢进性心脏病

J.C. Forfar, G.C. Caldwell
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引用次数: 42

摘要

心血管系统参与甲状腺机能亢进的重要性已被认识多年。在中老年患者中,常伴有轻度但长期的血浆甲状腺激素升高,心衰和并发心房颤动的症状和体征可能主导临床表现,掩盖了该疾病更经典的内分泌表现。讨论了诊断中的缺陷和早期识别和治疗的重要性。尽管实验证据表明甲状腺激素过量具有短期各向同性作用,但临床数据支持甲状腺机能亢进伴收缩储备受损的可逆性心肌病的存在。静息心肌功能增强主要反映甲状腺激素过量的外周作用。大多数(如果不是全部)心脏异常一旦达到甲状腺功能正常状态就会恢复正常,尽管心房颤动可能在少数人中持续存在。最佳治疗需要快速和明确的抗甲状腺治疗,通常使用大剂量放射性碘,并迅速控制心力衰竭。系统性抗凝是指房颤存在,并应继续,直到窦性心律已经存在至少三个月,自发或转复后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
9 Hyperthyroid heart disease

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the middle-aged and elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation may dominate the clinical picture and mask the more classical endocrine manifestations of the disease. Pitfalls in diagnosis and the importance of early recognition and treatment are discussed. Despite experimental evidence for a short-term isotropic action of thyroid hormone excess, clinical data support the existence of a reversible cardiomyopathy in hyperthyroidism with impaired contractile reserve. Enhanced myocardial performance at rest primarily reflects the peripheral actions of thyroid hormone excess. Most, if not all, of the cardiac abnormalities return to normal once a euthyroid state has been achieved, although atrial fibrillation may persist in a minority. Optimum treatment requires rapid and definitive antithyroid therapy, usually using a large dose of radio-iodine, and rapid control of heart failure. Systemic anti-coagulation is indicated in the presence of atrial fibrillation and should be continued until sinus rhythm has been present for at least three months, either spontaneously or after cardioversion.

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