OVERVIEW
OVERVIEW
Hyperthyroidism cardiomyopathy is a disease caused by a persistent elevation of serum triiodothyronine (T3) and/or thyroxine (T4) when the thyroid gland is hyperactive, which causes damage to the cardiac conduction system and cardiomyocytes. Clinical manifestations include fear of heat, excessive sweating, emotional irritability, palpitations, dyspnea, pain in the precordial area, rapid heart rate, hot and clammy skin, and muscle tremor.
Whether medical insurance
Yes
Department
Endocrinology, Cardiology
Clinical symptoms
Fear of heat, excessive sweating, agitation, palpitations, dyspnea, pain in the precordial area, rapid heart rate, hot and clammy skin, and muscle tremor.
Harm
It may lead to coronary insufficiency, myocardial infarction and heart failure due to prolonged tachycardia and arrhythmia, which is a serious threat to life.
Complications
Arrhythmia, heart failure, etc.
Tests
Thyroid function test, serum troponin T test, neuropeptide Y test, electrocardiogram, X-ray film, echocardiogram, nuclear examination, etc.
Diagnosis
Diagnosis is made on the basis of medical history and manifestations such as palpitations, dyspnea, precordial pain, combined with thyroid function test, serum troponin T test, echocardiography.
Treatment principle
Treatment of the primary disease is the main focus, and surgical treatment is available for severe cases.
Curability
Early treatment can effectively improve cardiac function.
Dietary recommendations
Give easy-to-digest high-protein, high-calorie, vitamin- and mineral-rich diet.
Important Reminder
Prevention and treatment of hyperthyroidism cardiomyopathy requires early treatment of hyperthyroidism, especially in people over 60 years of age.
Causes
Epidemiology
It occurs in people over 40 years of age, with a male-to-female ratio of 1:2, and the incidence accounts for 10% to 22% of patients with hyperthyroidism.
Etiology
When hyperthyroidism is present, T3 and/or T4 in the body are continuously elevated, cardiac contractility is increased, intraventricular pressure formation and contraction speed are accelerated, and long-term cardiac overload can induce cardiomyopathy.
Symptoms and Diagnosis
Typical symptoms
In addition to the symptoms of hyperthyroidism, such as fear of heat, excessive sweating, trembling fingers, agitation, hyper appetite, polyphagia, lethargy, muscle weakness, fatigue, and hyperactive bowel movement, there are also symptoms of cardiac lesions, such as sinus tachycardia, dyspnea, coronary insufficiency, and pain in the precordial area.
Other symptoms
Sometimes it may manifest as typical angina pectoris.
Diagnostic basis
A history of hyperthyroidism.2 Electrocardiography shows sinus tachycardia, atrial fibrillation, premature ventricular beats, ventricular tachycardia, atrioventricular block, and ST-T changes.3 X-rays usually show a normal-sized heart, but if atrial fibrillation persists or heart failure occurs, there may be an enlarged cardiac shadow and signs of pulmonary stasis.4 Echocardiography shows myocardial hypertrophy, dilated chambers, etc., which can involve the left ventricle, right ventricle, or the whole heart.5 Echocardiography shows myocardial hypertrophy, dilation of the chambers, etc., which may involve the left ventricle, right ventricle, or the whole heart. Left ventricle, right ventricle or whole heart.
Treatment
Treatment guideline
Treatment of the primary disease is the main focus, and surgery can be used in severe cases.
Drug therapy
Antihyperthyroid drugs are the first choice for treatment, and radioactive 131I treatment is also a better method. When the cardiac abnormalities cannot be corrected after hyperthyroidism is controlled, corresponding drug therapy can be used.1. Sinus tachycardia can be treated with β-blockers, such as propranolol, but there are side effects of aggravation of heart failure.2. The treatment of hyperthyroid heart failure is the same as that of heart failure in general except for etiologic treatment, and early application of β-blockers is beneficial to the correction of heart failure. The treatment of heart failure with hyperthyroidism is the same as that for heart failure in general. All heart failure has a reduced ejection fraction and left ventricular remodeling, so all should be treated with angiotensin-converting enzyme inhibitors (ACEIs).
Surgery
In severe cases, surgical treatment such as subtotal thyroidectomy may be performed depending on the condition.
Prognosis
With standardized treatment, cardiac function can be significantly improved.
Nursing care
Daily care
1. Follow doctor’s prescription for medication. 2. Avoid strenuous exercise, and move slowly when changing positions. 3. Follow doctor’s prescription for electrolyte supplementation, mainly potassium ions. 4. If there is cardiac insufficiency, try to lie in a semi-sitting or seated position to reduce the volume of returned blood and reduce the load on the heart.
Dietary management
Easily digestible high-protein, high-calorie, vitamin- and mineral-rich diet, appropriately reduce the amount of water consumption, and eat small meals. Avoid stimulating foods or drinks and iodine-rich foods.
Other Attention
*Title Chief Physician*Department of Endocrinology*Unit Information Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine*Writing Status Reviewed*Name Hongjie Yang