Klein M, Pascal V, Aubert V, Weryha G, Danchin N, Leclére J
CHU de Nancy, Clinique Médicale et Endocrinologique, Vandoeuvre-les-Nancy.
Ann Endocrinol (Paris). 1995;56(5):473-86.
Thyroid hormones may exert cardiovascular actions by direct effects on the myocardium, by interacting with the sympathetic nervous system and through alterations of the peripheral circulation. Then, thyroid hormones increase myocardial contractility and relaxation, sensitise the myocardium to sympathetic nervous system and decrease arterial resistance. Hyperthyroidism results in an enhanced myocardial contractility, an increased cardiac output and a fall in systemic vascular resistance. Nevertheless "high output" cardiac decompensation may occur. Thyrotoxicosis may trigger arrythmia and disease seems to be associated with an increase in the frequency of mitral valve prolapse. Even in mild or subclinical hyperthyroidism complication may occur. Sympathetic blocking agents are the treatment of choice in addition to aetiologic treatment. Hypothyroidism is associated with bradycardia, a decreased cardiac output, increased vascular resistance and perhaps a decreased sensitivity of the sympathoadrenal system. An increase in cholesterolemia leads to an additional risk for the development of atherosclerosis. Main cardiovascular complications of hypothyroidism are angina pectoris, diastolic hypertension, atrio-ventricular blocks or pericarditis. Mild hypothyroidism might also be correlated with an increase in adverse effects.
甲状腺激素可通过对心肌的直接作用、与交感神经系统相互作用以及改变外周循环来发挥心血管作用。甲状腺激素可增强心肌收缩力和舒张能力，使心肌对交感神经系统敏感，并降低动脉阻力。甲状腺功能亢进导致心肌收缩力增强、心输出量增加和全身血管阻力下降。然而，可能会发生“高输出量”的心功能不全。甲状腺毒症可能引发心律失常，且该疾病似乎与二尖瓣脱垂频率增加有关。即使是轻度或亚临床甲状腺功能亢进也可能出现并发症。除病因治疗外，交感神经阻滞剂是首选治疗方法。甲状腺功能减退与心动过缓、心输出量减少、血管阻力增加以及交感肾上腺系统敏感性可能降低有关。高胆固醇血症会增加动脉粥样硬化发展的额外风险。甲状腺功能减退的主要心血管并发症有心绞痛、舒张期高血压、房室传导阻滞或心包炎。轻度甲状腺功能减退也可能与不良反应增加有关。
