James J. Waring 62 



/ 



4. Myxedema with the heart enlarged, cardiac pulsations sluggish, and the 

 electrocardiogram characteristic. Under thyroid therapy all return to normal. 

 Zondek's "Myxodemherz." (Common.) Small pericardial effusion may explain 

 the enlargement. 



5. Myxedema with the heart enlarged and the electrocardiogram abnormal 

 but return of neither to normal under thyroid therapy. Irreversible changes 

 have taken place in the coronary vessels, either incidentally or as the result 

 of long continued myxedema. Forced thyroid therapy is dangerous. 



6. Myxedema with or without an enlarged heart, but with sluggish pulsa- 

 tions and electrocardiographic abnormalities, all of which return to normal 

 with cautious treatment. Angina may or may not be present. Forcing thyroid 

 therapy may cause death from acute coronary insufficiency. (Sturgis and 

 Whiting;" Fahr;"'^ Christian;'-' Ohler and Abramson.") 



7. Myxedema w^ith greatly enlarged cardiac silhouette due to pericardial 

 effusion, and characteristic electrocardiographic changes, all of which return 

 10 normal under thyroid therapy. (Gordon;'" Freeman."') 



Summary 



Detailed report has been given of a case of myxedema with enormous peri- 

 cardial effusion, ascites, and pleural effusion. Important publications on 

 "myxedema heart" have been reviewed and a classification of the heart changes 

 in myxedema offered. 



All basal metabolic and cholesterol determinations and glucose-tolerance tests were done 

 by members of the staff of the Department of Biochemistry under the supervision of Dr. 

 Robert C. Lewis, Dr. Robert M. Hill, and Dr. Bernard B. Longwell. 



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2. Zondek, H.: Miinchen. med. Wchnschr. 66:681, 1919. 



3. Assmann, H., and Leipzig, H.: Miinchen. med. Wchnschr. 66:9, 1919. 



4. Meissner, R.: Miinchen. med. \Vchnschr. 67:1316, 1920. 



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6. Fahr, G.: Jl. Amer. Med. Assn. 84:345, 1925. 

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8. Christian, H. A.: Rhode Island Med. Jl. 8:109, '925- 



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1 1. Willius, F. A., and Haines, S. F.: Amer. Heart Jl. 1:67, 1925. 



1 2. Means, J. H.; White, P. D., and Krantz, C. I.: Boston Med. & Surg. Jl. 195:455, 1926. 



13. Lerman, J.; Clark, R.J. , and Means, J. H.: Ann. Internal Med. 6:1251, 1933. 



14. Means, J. H.: New England Jl. Med. 208:541, 1933. 



15. Lerman, J.; Clark, R. J., and Means, J. H.: Ann. Internal Med. 8:82, 1934. 



16. Means, J. H.: The Thyroid and Its Diseases (Philadelphia: 1937). 



17. Fahr, G.: Amer. Heart Jl. 8:91, 1932. 



18. Sturgis, C. C, and Whiting, W. B.: Jl. Amer. Med. Assn. 85:2013, 1925. 



19. Ohler, W. R., and .^bramson, J.: Archs. Internal Med. 53:165, 1934. 



