6i 2 The Heart in Myxedema 



cured by thyroid therapy, may be present for many years. Fahr describes the 

 "myxedema heart" as follows: All chambers of the heart are dilated, some- 

 times enormously; the T wave in lead I is absent or negative; all cases show 

 negative Q-R-S complexes in lead III during the stage of marked cardiac dila- 

 tation; during thyroid medication, the dilatation of the heart disappears rap- 

 idly and the T wave becomes positive. During the transition from a negative 

 to a positive T wave, the T wave may be temporarily diphasic. A few cases 



TABLE 1* 

 Myxedema: Symptoms and Signs 



I. General V. Circulatory 



1 . Fatigue i . Shortness of breath 



2. Weakness 2. Slow pulse 



3. Intolerance to cold 3. Low pulse pressure 



4. Subnormal temperature 4. Decreased minute volume, cardiac 



5. Defective temperature regulation output 



6. Increase in weight 5. Decreased blood volume 



7. Increase in water content of the body 6. Increase in heart size 



8. Serous effusions 7. Poor quality heart sounds 



9. Local "tumefactions" 8. EKG changes 



10. Slow speech 9. Feeble heart sounds 



1 1. Deep, monotonous voice 10. Feeble heart movements 



12. Joint pains and muscle stiffness ^,r ^^ 11 

 ■' 1 VI. Neurological 



13. Intolerance to morphine and disjitalis t-> • -. 1 -i-^ 

 ^ 10 1. Drowsniess, excitability 



II. Skin 2. Mental disorders 



1. Pale, cold, dry, scaly 3. Slowness of thought and movement 



2. Inelastic 4. Numbness and tingling 



3. Absence of sweating 5. Impairment of memory 



4. Hair, thin, coarse 6. Deafness 



5. Brittle nails 7. Prolongation of tendon reflexes 

 ^„ p. J 8. Electroencephalogram 



T, ,.j q. Diminution of tone in autonomic 



1. Eyelids -^ 



r J u 1 system 



2. Face and cheeks ^ 



. ,, 10. Increased protein in spinal fluid 



4. Turgescence, infiltration of mucous VII. Gastrointestinal 



membranes 1. Poor appetite 



TTT Ti . 1 • 2. Achlorhydria 



IV. Hematologic ' 



T J u 1 . 1 ^- Indisjestion 



1. Increased cholesterol ^ =■ 



. ■ 4. Constipation 



2. Anemia ^ ^ 



„ , . . K. Hemorrhoids 



3. Hyperproteinemia -^ 



4. Decline in blood iodine VIII. Bladder atony 



IX. Amenorrhea, menorrhagia, metrorrhagia 

 X. Low BMR 



XL Apparent absence of thyroid 

 XII. Improvement with thyroid therapy 



* Modified from a similar table of Means. 



