CORRELATION OF CLINICAL AND HEMODYNAMIC STUDIES IN PATIENTS WITH HYPERTHYROIDISM WITH AND WITHOUT CONGESTIVE HEART FAILURE
CORRELATION OF CLINICAL AND HEMODYNAMIC STUDIES IN PATIENTS WITH HYPERTHYROIDISM WITH AND WITHOUT CONGESTIVE HEART FAILURE
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DOI：
10.1172/jci103906
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发表时间：
1959-01-01
影响因子：
15.9
通讯作者：
CAMPBELL, JA
中科院分区：
文献类型：
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作者：
GRAETTINGER, JS;MUENSTER, JJ;CAMPBELL, JA
在 14 名没有充血性衰竭的患者中，尽管其中 6 名患者既往患有心脏病，但运动期间的血流动力学反应基本正常。 7 例充血性衰竭患者中，4 例心输出量绝对水平正常，3 例显着升高。所有患者的心输出量对运动的反应均不足。心房颤动仅发生在患有充血性衰竭或既往患有心脏病的患者中。从这些研究得出的结论是，在甲状腺毒症过程中，充血性心力衰竭可能通过多种机制发生：（1）先前的心脏病可能会降低心肌储备，（2）甲状腺素可能会暂时降低心脏的心肌储备，（3）疾病增加的循环负荷甚至可能明显超过正常心脏的储备。当负荷增加导致心肌储备减少是主要异常时，心输出量趋于“正常”范围。当储备减少较少而循环负荷增加较多时，心输出量可能会非常高。甲状腺毒症的外周循环负荷在血流动力学上与全身动静脉瘘相似。
In 14 patients without congestive failure the hemodynamic responses during exercise were qualitatively normal despite the fact that 6 had antecedent heart disease. In the 7 patients who had been in congestive failure, the absolute level of cardiac output was normal in 4 and markedly elevated in 3. All had inadequate responses of the cardiac output to exercise. Atrial fibrillation occurred only in the patients with congestive failure or with antecedent heart disease. From these studies it is concluded that congestive heart failure may occur during the course of thyrotoxicosis by several mechanisms: (1) myocardial reserve may be reduced by antecedent heart disease, (2) thyroxin may transiently reduce the myocardial reserve of the heart, and (3) the increased circulatory load of the disease may apparently overcome the reserve of even the normal heart. When the decrease in myocardial reserve in the presence of the increased load is the major abnormality, the cardiac output tends to be in the "normal" range. When the decrease in reserve is less and the increase in circulatory load greater, the cardiac output may be remarkably high. The peripheral circulatory load in thyrotoxicosis is hemodynamically similar to that of a systemic arterio-venous fistula.