James J . Waring 6 1 5 



attacks (Thompson"'), in both instances disappearing when thyroid medica- 

 tion was temporarily withdrawn, have been reported. On the other hand, the 

 pain of angina in myxedema may disappear dining thyroid therapy, as in the 

 case reported by Ziskin." The blood pressure in myxedema may be low, nor- 

 mal, or moderately elevated. Under treatment the general tendency is for the 

 jjressme to move toward a normal range (Ohler and Ullian"''). 



In a valuable study of thirty-five cases of myxedema seen at the Boston City 

 Hospital in the preceding seven years Ohler and Abramson'" found character- 

 istic changes in the electrocardiograms in thirteen, namely decrease in voltage 

 in all the complexes and frequently an inversion of the T waves in all leads. 

 The T waves in lead I were abnormal in every one of these thirteen. Also the 

 P curves were low in all but one case. Prolonged A-V time was occasionally 

 seen and convex S-T intervals in three cases. With few exceptions these changes 

 were observed when the basal metabolic rate dropped to a level of —25 or 

 lower. In some cases under treatment it was noticed that the electrocardio- 

 graphic changes returned to normal before the basal metabolic rate had risen 

 to normal. Enlargement of the heart occurred in seven of the thirteen cases 

 showing electrocardiographic changes. With one exception, perhaps due to 

 the brief period of treatment, the increased size of the heart was reduced as a 

 residt of thyroid therapy. In several instances, therefore, the heart was not 

 enlarged and yet the electrocardiogram was characteristic. Distant heart sounds 

 and "mild congestive failure" were frequently found. They conclude: "The 

 changes noted in this series are characteristic of the disease and warrant the 

 use of the term, 'myxedema heart.' " 



Ohler and Abramson suggest that the presence of a myxedematous infiltra- 

 tion of the heart, a mucinous tissue involving the muscidar fibers and inter- 

 fibrillar spaces and nervous elements of the heart, which disappears with 

 thyroid therapy, may in small quantity produce only changes in the electro- 

 cardiogram without increase in size of the heart, but in larger quantities w^ill 

 cause dilatation. They do not believe that resistance of the skin can cause in- 

 version of the T waves nor prolongation of the conduction time. Coelho"* does 

 not think cutaneous resistance important, since the use of needle electrodes 

 gave the same results as ordinary electrodes. Paul White also by the use of 

 needle electrodes showed that the altered conductivity of the myxedematous 

 skin had no influence on the graphic records. 



Bellet and McMillan"" ascribe the electrocardiographic changes to alteration 

 in the myocardium. The low voltage may be explained by easier dissipation 

 of the heart current through the myxedematous tissue. They do not mention 

 S-T displacements among the characteristic changes. 



Ohler and Abramson'^ call attention to the close resemblance between the 

 variations in the electrocardiogram in certain cases of myxedema and the 

 picture not infrequently seen in coronary sclerosis as originally described by 

 Pardee. The low voltage, the inverted T waves, and the upward convexity 

 of the S-T interval are common to both diseases. However, in their cases of 



