Covert hypothyroidism presenting as a cardiovascular event
Article Abstract:
Among the signs associated with heart attack is an elevation in blood levels of creatine phosphokinase (CPK), an enzyme which leaks from heart muscle when it is damaged. However, high CPK levels may occur in up to 90 percent of cases of hypothyroidism (low levels of thyroid hormone). These patients may have symptoms more suggestive of cardiovascular disease than of thyroid problems. Distinguishing between these two types of disorders may be facilitated by observing the pattern of CPK elevation; with hypothyroidism, the pattern persists, but not with heart attacks. Of 337 patients admitted to a coronary care unit, 6 were diagnosed with hypothyroidism; all had elevated CPK levels. Features of these six cases are discussed. The patients were all male, aged 30 to 51, five had chest pain, and one had severe high blood pressure. Five had nonspecific electrocardiographic changes and there was initial concern about damage to the heart muscle. One patient did have a heart attack, and CPK levels were consistent with heart disease. However, the CPK elevation persisted in all six patients and consisted of skeletal muscle-associated CPK, even in the patient with the heart attack. All six patients had small thyroid glands and significant levels of antibodies against thyroid molecules. Chest pain in four patients resolved with thyroid hormone treatment, while long-term antihypertensive therapy was required for the patient with high blood pressure. Asymptomatic myopathy (muscle disease) associated with hypothyroidism was responsible for the elevated CPK in these cases. This report illustrates the need to consider hypothyroidism in cases of chest pain where the pattern of CPK elevation is unusual. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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The antiphospholipid syndrome: prevalence among patients with stroke and transient ischemic attacks
Article Abstract:
Antiphospholipid antibodies are abnormal immune, or natural defense, proteins that specifically bind to phosphate-containing lipids or fatty groups. These antibodies have been associated with recurrent blood clotting, repeated miscarriage, and an abnormal decrease in the number of platelets (which are cells involved in blood clotting). Lupus anticoagulant, a factor that prevents or delays blood clotting, has been detected in patients with lupus erythematosus, an inflammatory disorder of connective tissue. The combined presence of lupus anticoagulant, antiphospholipid antibodies, and related symptoms has been referred to as the antiphospholipid syndrome. Both antiphospholipid antibodies and lupus coagulant have been detected in patients with stroke, and may serve as markers for the clotting state of these patients. Stroke is the sudden loss of consciousness followed by paralysis, and results from the blockage of blood vessels supplying the brain or from bleeding within the brain due to rupture of a blood vessel. The prevalence of the antiphospholipid syndrome was assessed in 51 patients with stroke and transient ischemic attacks (brief episodes of cessation of blood supply to the brain). Among 51 patients, 3 had lupus anticoagulant and symptoms of the antiphospholipid syndrome; 7 patients had clinical symptoms, but no laboratory evidence of the syndrome. Patients without clinical symptoms of this syndrome did not have laboratory evidence of the disease. These findings indicate that clinical features are useful indicators of the antiphospholipid syndrome. The role of lupus anticoagulant in the disease process which leads to stroke requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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