THE HEART IN MYXEDEMA 



THE ASTONISHING iiumber and variety of the signs and symptoms of myx- 

 edema (table i), their intriguing nature, the possibihties of accurate 

 diagnosis of a malady that frequently masquerades as pernicious anemia or 

 cardiorenal disorder, the remarkable mental, spiritual, and physical re- 

 juvenation wrought by thyroid therapy have all contrived to make myxedema 

 a disease fascinating to the clinician. This paper is a review of previously 

 published observations on the changes in the heart in myxedema and a report 

 of a case with enormous pericardial effusion. 



Experimental work on thyroidectomized animals as well as many clinical 

 observations on myxedema in human beings all indicate the early develop- 

 ment of cardiovascular disease of degenerative nature in the absence of the 

 normal secretion of the thyroid gland. Evidences of cardiovascular disease 

 consist in the main of arteriosclerosis, interstitial edema of the myocardium, 

 swollen or vacuolated heart-muscle cells, and pericardial effusions. 



Around H. Zondek's paper of 1918^ on "Myxodemherz," giving details of 

 four cases of heart failure due to thyroid deficiency and cured by thyroid 

 medication, has arisen a lively discussion on the heart in myxedema. Zondek 

 said all chambers of the heart were dilated, the heart action under the fluoro- 

 scope w^as indolent, the pulse slow, and the blood presstae normal. In the 

 electrocardiogram he noted marked diminution in the P and T waves. After 

 treatment with thyroid he observed striking reduction in size of the heart, 

 more vigorous action of the heart under the fluoroscope, a more rapid pulse 

 without change in the blood pressure. In the electrocardiogram he observed 

 a gradual return of the P and T waves to normal. In 1919 Zondek" said the 

 aorta was dilated as well as both sides of the heart. In the electrocardiogram, 

 P and T waves were greatly diminished or absent from normal cardiac cycles 

 but were present in association with extrasystolic complexes. Under treatment 

 the heart returned to normal size but the aorta still remained dilated. If in the 

 course of treatment with thyroid the waves of the electrocardiogram become 

 abnormally high ("Basedowkardiogram"), treatment should be reduced or 

 stopped altogether. Finally in certain forms of myxedema, the cardiovascular- 

 system complex may suggest the correct diagnosis. 



Although Assmann,^ Meissner,* and Zins and Rosier' in Germany and 

 Fahr" in the United States published cases in substantial agreement with 

 Zondek, others doubted if a cardiac abnormality existed sufficiently character- 

 istic of myxedema to justify the term "myxedema heart." Fahr believes that 

 heart failure is a prominent feature of an outspoken case of myxedema and 

 furthermore that a mild degree of heart failure with very slight dilation of 

 the heart is not at all infrequent in women patients past forty-five years ex- 

 hibiting slight but definite evidence of hypothyroidism. Objective as well as 

 subjective signs of heart failure, which do not respond to digitalis but are 



