Aronow W S
Hebrew Hospital Home, Bronx, New York, USA.
Clin Geriatr Med. 1995 May;11(2):219-29.
This article discusses the effects of thyroid hormone on the heart, cardiovascular symptoms and signs in elderly patients with hyperthyroidism and hypothyroidism, and the diagnosis and therapy of hyperthyroidism and hypothyroidism in elderly patients. Cardiovascular symptoms of hyperthyroidism include palpitations, angina, pectoris, and dyspnea on exertion, orthopnea, or paroxysmal nocturnal dyspnea. Atrial fibrillation or congestive heart failure may be the only clinical manifestation of hyperthyroidism in elderly patients with apathetic hyperthyroidism. Atrial fibrillation with a rapid ventricular rate due to hyperthyroidism should be treated with propranolol to control the rapid ventricular rate. Elderly patients with coronary artery disease and hypothyroidism should be treated cautiously with thyroid hormone replacement to avoid precipitating or exacerbating angina pectoris, precipitating acute myocardial infarction, and precipitating or aggravating ventricular arrhythmias or congestive heart failure.
本文讨论了甲状腺激素对心脏的影响、老年甲亢和甲减患者的心血管症状和体征，以及老年甲亢和甲减的诊断与治疗。甲亢的心血管症状包括心悸、心绞痛、劳力性呼吸困难、端坐呼吸或阵发性夜间呼吸困难。在淡漠型甲亢的老年患者中，心房颤动或充血性心力衰竭可能是甲亢的唯一临床表现。因甲亢导致心室率快速的心房颤动应使用普萘洛尔治疗以控制快速的心室率。患有冠状动脉疾病和甲减的老年患者在进行甲状腺激素替代治疗时应谨慎，以免诱发或加重心绞痛、引发急性心肌梗死，以及诱发或加重室性心律失常或充血性心力衰竭。
