thyrocardiac syndrome

1. THYROCARDIAC SYNDROME PROFESSOR / MOHAMMED AHMED BAMASHMOS PROFESSOR OF INTERNAL MEDICINE AND ENDOCRINOLOGY

2. DEFINITION Thyro-cardiac disease describes the existence of a combination of thyroid toxicity and significant heart disease in an individual patient. The frequent manifestations of thyro-cardiac disease are hypertension, atrial flutter or fibrillation, pulmonary hypertension and dilated cardiomyopathy. Defination - thyrotoxisis - hyperthyroidism

3. PATHOGENESIS

4. BENEFICIAL EFFECT OF THYROID HORMONE

5. PATHOGENESIS OF CVD IN HYPERTHYROIDISM

7. TYPES 1- Arrhythmia , atrial fibrillation ( 10-15 %) 2- Hypertension ( 20-30%) 3- CAD ( Angina , coronary spasm 4- Herat failure ( 6% ) 5- Valvular heart diseases 6- Pulmonary H 7- thyrocardiac crisis associated with thyrotoxic storm ( acute HF , Pulmonary edema , AF

8. ARRHYTHMIA Types

9. PATHOGENESIS OF AF

10. HYPERTENSION prevalence

11. Heart failure types ; - heart failure in the absence of prior cardiac injury ( due to increased cardiac output and contractility ) - true heart failure ( decreased cardiac output , abnormal diastolic compliance , and pulmonary congestion ) pathogenesis of thyro toxic cardiomyopathy

13. VALVULAR HEART DISEASES

14. PULMONARY HYPERTENSION Approximately 20% of patients with pulmonary hypertension have thyroid disease as a comorbidity, which is more frequent than the general population. Several mechanisms have been suggested in the pathogenesis of pulmonary hypertension in patients with Graves' hyperthyroidism, - autoimmune process associated with endothelial damage or dysfunction, - increased cardiac output resulting in endothelial injury, -increased metabolism of intrinsic pulmonary vasodilating substances

15. CORONARY ARTERY DISEASES - IHD - Coronary artery spasm

16. Clinical features Diagnosis ; - diagnosis of hyperthyroidism

17. diagnosis of CVD ; - cardiac markers - CXR - ECG ECHO

18. Treatment ; 1- treatment of hyperthyroidism A- medical

19. B- surgical C- radioactive iodine

21. 2- treatment of associated CVD Patients with long standing hyperthyroidism

22. A- proper treatment of hyperthyroidism ; lead to recovery of all CVD B- usual treatment of different types of CVD that are associated with hyperthyroidism Atrial fibrillation Rhythm control is usually not recommended in patients with hyperthyroidism and atrial fibrillation as nearly two-thirds of patients revert to normal sinus rhythm 8–10 weeks after achieving a euthyroid state. In those patients who continue to remain in atrial fibrillation after achieving a euthyroid state, rhythm control may be an option however like the general atrial fibrillation population, rate control is usually preferred initially. Options for rhythm control include class IA, IC as well as class III agents. The use of amiodarone may be indicated acutely as mentioned above during a thyroid storm to restore sinus rhythm or for chronic therapy in those with atrial fibrillation refractory to rate control. While the use of amiodarone has not been clearly studied in those with thyrotoxic atrial fibrillation, amiodarone is known to cause hyperthyroidism as well as hypothyroidism

23. heart failure ; Hypertension ;

24. IN THYROCARDIAC STORM Its defined as severe hyperthyroidism that are associated - severe tachycardia - acute HF - AF - Coronary spasm - cardiogenic shock - precipitating factors

25. - clinical features ;

26. Diagnosis ;

27. Diagnostic algorithm

28. TREATMENT

29. 1- of thyrotoxic storm ;

30. 2- treatment of associated CVD - Heart failure

31. 2- Atrial fibrillation