Myxedema Heart Disease

In recent years there have appeared occasional reports of cases of hypothyroidism in which associated findings have been interpreted as evidence of the presence of myxedema heart disease. Fahr5 has pointed out the lack of consideration which has been given to the cardiac features of hypothyroidism in text-books, and until the recent publication of a volume12 devoted to heart disease the space given to this subject was limited. There is no doubt that an advanced grade of hypothyroidism is an uncommon condition and, furthermore, that a striking degree of myxedema heart disease is rare, however, the dangers attendant upon its improper management, and its response to careful therapy make its consideration a matter of importance. Following the reports of a small number of cases by Zondek"4, by Assman1 and by Meissner9, Fahr' reported six cases which he considered typical of myxedema heart disease. One of his cases was relieved of congestive failure by thyroid extract therapy after rest and digitalis had failed. Other clinicians have been sceptical of the existence of this clinical entity. Willius and Haines"3 reviewed 162 cases of hypothyroidism and were unable to find any instance of cardiovascular disease which they could definitely attribute to myxedema, but only a few of these cases were carefully studied for changes in the cardiac diameters and in the electrocardiagram both before and after thyroid extract therapy. Christian3 reviewed 32 cases and failed to find any with cardiac findings similar to those described by Fahr6, but he emphasized the importance of cautious thyroid extract therapy where cardiac disease might be present. More recently, reports of cases of myxedema heart disease which have been carefully studied have been published by Means, White and Krantz8, Holtzman7, Davis4, Tung"1 and others, and furnish convincing evidence that the cardiovascular system must not be overlooked in planning the treatment of myxedema. Ayman, Rosenblum and Falcon-Lesses2 have reported two cases of myxe-