narrative pathophysiology of cardiothyrotoxicosis
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Transcript of narrative pathophysiology of cardiothyrotoxicosis
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7/30/2019 narrative pathophysiology of cardiothyrotoxicosis
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NARRATIVE:
Hyperthyroidism includes diseases that are a subset of thyrotoxicosis that are
caused by excess synthesis and secretion of thyroid hormone by the
thyroid. Thyrotoxicosis is the hypermetabolic condition associated with elevated levels
of free thyroxine (T4) and/or free triiodothyronine (T3).
The over stimulation of the thyroid gland leads to hyperplasia of the gland and
subsequently this leads to an increase in the secretion of thyroid hormones. The growth
in the cells and its multiplication manifest in enlargement of the gland. Noticeable
changes occur in all parts of the body as a result of the increased hormone secretion.
There is elevation in metabolic rate manifesting in elevation in metabolism of protein, fat
and carbohydrate. The accelerated protein and fat metabolism lead to weight loss and
muscular weakness. The body attempts to remedy the weight loss and so the patient's
appetite is increased in the process.
Patient is unable to tolerate hot weather as a result of the increase in the body
metabolism. The superficial capillaries dilate leading to increased peripheral blood flow
and also an increase in cardiac output as the body tries to eliminate excess heat fromthe system. This accounts for warm and moist skin and also for the perspiration.
The increase cardiac output in conjunction with hormonal effects on the
sympathetic nerves brings about palpitation and tachycardia. There may be ectopic
beats or atrial fibrillation in the elderly. There is increase in systolic blood pressure and
the pulse pressure. The heart tries to compensate for these increases and may
eventually become overwhelmed and fail.The hemodynamic features of hyperthyroidism
are due to functional alterations in both the peripheral circulation and the myocardium.
There is an increase in total blood volume and a decrease in systemic vascular
resistance . These effects increase preload and decrease afterload and are
accompanied by an increase in heart rate and myocardial contractility . The result is a
high output cardiac state.
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Patients with CHF usually present to the hospital with signs of fluid overload.
They become short of breath due to the buildup of excess fluid in the lung. The fluid
excess interferes with the transfer of oxygen from air to blood. Classically this has been
attributed to abnormal heart muscle function where the heart muscle is weakened (by
heart attack, hypertension, or other causes) and can no longer pump blood efficiently.
The heart is stiff and requires higher pressure to fill it between heartbeats. The period
between heartbeats when the heart fills is called diastole, and this form of heart muscle
disease is called diastolic heart failure. Much less is known about this form of CHF in
spite of the fact that up to half of the heart failure treated in hospital in diastolic CHF.
The most common identifiable cause of diastolic heart failure by far is hypertension.
There will be a condition called Pleural Effusion caused by Left sided heart failuerev-
the accumulation of fluid in the pleural cavity that is caused by the backflow of blood
from the left ventricle. Symptoms such as crackles, dyspnea, and blood tinged
secretions will occur.
Portal Hypertension happens when unoxygenated and detoxified blood goes to
the right atrium. For patients with Right Sided Heart Failure there will be ineffective
pumping of blood therefore accumulation of blood in the right ventricle causes
congestion. There will be a backflow of accumulated blood back to the hepatic vein
down to the liver and the portal vein. Increase accumulation of blood in the portal vein
causes Portal Hypertension.
With proper management such as Management such as: oxygen therapy,
intubation, use of mechanical ventilator, cardiac monitoring, suctioning, OF feeding via
NGT, semi-fowlers position, nebulization. The patient will be able to improve his/her
cardiac output, have effective tissue perfusion, restored oxygenation of tissue and cells
leading to cell recovery, therefore multi- organ system failure is PREVENTED leading to
good prognosis.
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Without proper management, Patient will deteriorate, less oxygenated blood in
the circulation and in the cells, therefore there will be cell death and multi-organ system
failure leading to poor prognosis and eventually death.