Heart disease Hyperthyroidism

Phenylephrine is a nasal decongestant that mimics the sympathetic system, thereby increasing the heart rate and blood pressure. It may aggravate conditions such as diabetes, hypertension and glaucoma. Patients with hypertension, ischaemic heart disease, hyperthyroidism, diabetes and glaucoma are therefore given topical nasal sympathomimetics rather than systemic sympathomimetics. Both topical and systemic sympathomimetics are contraindicated in patients taking monoamine oxidase inhibitors, because concurrent administration of the two products may lead to a hypertensive crisis. 

Caution Treated open-angle glaucoma, autonomic neuropathy, pulmonary disease, esophageal reflux, hiatal hernia, heart disease, hyperthyroidism, hypertension... 

Indications Liver/kidney yin deficiency, liver yang ascendancy, qi and blood counterflow and chaos. Wind stroke, convulsions, epilepsy, cerebrovascular accident, aphasia, apraxia, renal hypertension, essential hypertension, hypertensive encephalopathy, cerebral arteriosclerosis, arteriosclerotic heart disease, hyperthyroidism, premenstrual tension, postpartum fever with spasms and convulsions, and glaucoma... 

Oral decongestants are not strongly associated with rhinitis medicamentosa but are associated with systemic adverse effects, e.g., blood pressure elevation, palpitations, tremor, appetite loss, and insomnia. Oral decongestants should be used with caution in patients with cardiac disease (arrhythmias, high blood pressure, coronary heart disease), hyperthyroidism, glaucoma, diabetes, and urinary dysfunction. Pseudoephedrine is less likely to elevate blood pressure than phenyl propanolamine (64). 

The decongestants are used cautiously in patients with hyperthyroidism, diabetes mellitus, prostatic hypertrophy, ischemic heart disease, and glaucoma Safe use of the... 

About 4.5 million Americans have heart failure (HF). It is the most frequent cause of hospitalization for individuals older than 65 years. Some patients, with treatment, may lead nearly normal lives, whereas more than 50% of individuals with severe HF die each year. HF is a complex clinical syndrome that can result from any number of cardiac or metabolic disorders such as ischemic heart disease, hypertension, or hyperthyroidism. Any condition that impairs the ability of the ventricle to pump blood can lead to HF In HF, die heart... 

Common adverse reactions seen with phentermine use include heart palpitations, tachycardia, elevated blood pressure, stimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, dry mouth, constipation, and diarrhea. Phentermine should be avoided in patients with unstable cardiac status, hypertension, hyperthyroidism, agitated states, or glaucoma. In combination with fenfluramine or dexfenfluramine, pulmonary hypertension and valvular heart disease have been reported. The risk of developing either serious adverse effect cannot be ruled out with use of phentermine alone. Since phentermine is related to the amphetamines, the... 

Cardiac and other effects Symptoms of hyperthyroidism, coronary heart disease,... 

Special risk patients Administer with caution to patients with diabetes mellitus, hyperthyroidism, prostatic hypertrophy (ephedrine) or history of seizures elderly psychoneurotic individuals, patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease (epinephrine). 

Special risk Use with caution in the presence or history of the following Hypertension diabetes hyperthyroidism heart disease cerebral arteriosclerosis bronchial asthma. 

Contraindications Cardiac arrhythmias, cerebrovascular insufficiency, hypertension, hyperthyroidism, ischemic heart disease, narrow-angle glaucoma, shock... 

There has been a retrospective study of the frequency of amiodarone-associated thyroid dysfunction in adults with congenital heart disease (41). Of 92 patients who had taken amiodarone for at least 6 months (mean age 35, range 18-60 years), 36% developed thyroid dysfunction— 19 became hyperthyroid and 14 hypothyroid. The mean dosage was 194 (100-300) mg/day, and the median duration of therapy was 3 (0.5-15) years. Female sex (OR = 3) and unoperated or palliated cyanotic congenital heart disease (OR = 7) were significant susceptibility factors for thyroid dysfunction. The risk was also dose-related. Although the authors conceded that they may have over-estimated the... 

These compounds seem to produce some of the paradoxical reactions often observed with amphetamine and thus should be handled with caution. A short pamphlet from Stash, a psychedelic information service, warns against use of MDA by "Persons with heart disease, severe high blood pressure, hyperthyroidism or diabetes mellitus. MDA was described by Alles as being a third as potent as amphetamine in vaso-constrictive effects. The... 

Adverse effects of thyroid hormone parallel the increase in metabolic rate. The symptoms and signs are those of hyperthyroidism. Symptoms of myocardial ischaemia, atrial fibrillation or heart failure are liable to be provoked by too vigorous therapy or in patients having serious ischaemic heart disease who may even be unable to tolerate optimal therapy. Should they occur levothyroxine must be discontinued for at least a week and begim again at lower dosage. Only slight overdose is needed to precipitate atrial fibrillation in patients over 60 years. 

Be careful to rule out coronary heart disease and hyperthyroidism... 

The most severe form (f hyperthyroidism is thyroid storm, a rare but life-threatening disease that usually is precipitated by an intercurrent medical problem. Precipitating factors include infections, stress, trauma, thyroidal or nonthyroidal surgery, diabetic ketoacidosis, labor, heart disease, and rarely, radioactive iodine ablation. Clinical features are similar to those of thyrotoxicosis, but are more severe. Cardinal features include fever and tachycardia out of proportion to the fever. Nausea, vomiting, diarrhea, agitation, and confusion are frequent presentations. The abnormalities in TFTs are not necessarily worse than those in uncomplicated thyrotoxicosis and thyroid storm is a clinical diagnosis. 

Th e dm are used cautiously during pregnancy (epinephrine and apraclonidine, Pr nancy Cat ory C dipivefrin, Piregnancy Category B) and lactation and in patients witii hypertension, diabet, hyperthyroidism, heart disease, cerebral arteriosclerosis, or bronchial asthma. Some of these dru contain sulfite that may cause allergic-like reactions (hives, wheezing, anaphylaxis) in patients with sulfite sensitivity. See Chapter 22 for information on interactions. 

Cardiac arrhythmias commonly occur in the presence of preexisting heart disease. They are the most common cause of death in patients who have had a myocardial infarction. They are also the most serious manifestation of digitalis toxicity and are often associated with anesthesia, hyperthyroidism, and electrolyte disorders. 

With the production of artificial radioactive substances in 1934. the field of nuclear medicine was established. In 1937, the first radioactive isotope was used to treat a person with leukemia at the University of California at Berkeley. Major strides in the use of radioactivity in medicine occurred in 1946, when a radioactive iodine isotope was successfully used to diagnose thyroid function and to treat hyperthyroidism and thyroid cancer. Radioactive substances are now used to produce images of organs, such as liver, spleen, thyroid gland, kidneys, and the brain, and to detect heart disease. Today, procedures in nuclear medicine provide information about the function and structure of every organ in the body, which allows the nuclear physician to diagnose and treat diseases early. 

Jonckheer MH, Blockx P, Kawers R and Wyffels W. 1973. Hyperthyroidism as a possible complication of treatment of ischemic heart disease with amiodarone. Acta Cardiol (Bruxelles) 28, 192-200. 

Physical or psychological stress, hypoxia, hypokalemia, cardiomyopathy, congenital heart disease. Ml, valvular disease, WoHf-Parkinson-White syndrome, cor pulmonale, hyperthyroidism, and systemic hypertension. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

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