INFLUENCE OF SUBCLINICAL HYPOTHYROIDOSIS ON THE CLINIC AND SOME INDICATORS OF CARDIOGEMODYNAMICS IN PATIENTS WITH STABLE ISHEMIC HEART DISEASE
DOI:
https://doi.org/10.11603/1811-2471.2017.v0.i2.7726Keywords:
stable ischemic heart disease, subclinical hypothyroidism, clinic, diastolic dysfunction.Abstract
Introduction. At this time, there is enough evidence to support the idea that the heart and blood vessels can be considered as potential target organs for hypothyroidism. In this case, both the manifest hypothyroidism and the subclinical have a negative effect on the cardiovascular system.
The aim of the study was to evaluate the influence of subclinical hypothyroidism in patients with stable ischemic heart disease on the clinic, some echocardiographic indices and the parameters of the Holter monitoring of ECG.
Material and methods of investigation. 39 patients with stable ischemic heart disease were examined, and 19 had subclinical hypothyroidism. A clinical study, echocardiography, Holter monitoring of ECG, a test with 6-minute walking were conducted.
Results. It was established that the peculiarity of clinical manifestations of stable angina of exertion in patients with subclinical hypothyroidism are frequent attacks of atypical low-grade anginal syndrome in the presence of dyspnea, rapid fatigue. Subclinical hypothyroidism in patients with stable exertional angina worsens the course of the disease due to significantly more frequent episodes of pain and painless myocardial ischemia with ST-segment depression (p <0.05) and greater mean duration it between the compared groups (p <0.05), and a significantly lower left ventricular ejection fraction and tolerance to physical exertion. Patients with subclinical hypothyroidism showed signs of diastolic dysfunction of the left ventricle in a pseudo normal type (78.9%), whereas in patients with preserved thyroid status, diastolic dysfunction with a violation of relaxation (85%) was more reliably diagnosed.
Conclusions. In patients with stable ischemic heart disease, the presence of subclinical hypothyroidism leads to a more frequent occurrence of painless episodes of myocardial ischemia and the formation of an atypical clinical picture of stable angina, an early appearance of nonspecific symptoms of chronic heart failure and a faster progression of diastolic left ventricular dysfunction, which contributes to a more severe course of the disease. Investigation of changes in the parameters of cardio hemodynamics allows to diagnose chronic heart failure at early stages of its development in patients with stable ischemic heart disease in combination with subclinical hypothyroidism and thereby opens the prospects for timely and adequate treatment of various types of myocardial dysfunction.
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