ЖЕЛУДОЧКОВАЯ ЭКСТРАСИСТОЛИЯ И ТИРЕТОКСИКОЗ

Уважаемый Руслан!







Я
не знаю, что заставило Вас углубляться в литературу почти вековой давности.



Cardiac
arrhythmias



Hyperthyroidism
is associated with atrial arrhythmias, dysfunction of the sinus node, and
supraventricular ectopic beats. Untreated patients with Graves
disease or toxic multinodular goiter have a high incidence of premature
ventricular contractions (PVCs).



Наличие желудочкеовой экстрасистолии
при тиреотоксикозах встречаеься реже, чем мерцательная аритмия, но чаще, чем
предсердные экстрасистолы.



Посылаю Вам абстракты двух
сравнительно свежих работ на эту тему. И хочу подчеркнуть, что наличие
желудочковых экстрасистол не может и не должно являться самоцелью при тиреотоксикозе.
Надо подавлять сам тиреотоксикоз, а не его отдельные, причем далеко не самые
важные, кардиологические симптомы.



Am Heart J. 1986 Aug;112(2):339-44.

Continuous 24-hour electrocardiography in
thyrotoxicosis before and after treatment.



Northcote RJ, MacFarlane P, Kesson CM, Ballantyne D.

Abstract



Ten thyrotoxic individuals, who otherwise had no
evidence of cardiovascular disease, underwent continuous ambulatory 24-hour ECG
monitoring, before and after antithyroid treatment. The mean age of the
subjects was 41 +/- 14.4 years (mean +/- SD) with a range of 22 to 66 years.
When subjects were thyrotoxic, the mean heart rate for the group was 104 +/-
10.8 bpm. This fell to 82 +/- 6.8 bpm when the subjects were rendered euthyroid
(p less than 0.001). Circadian rhythm of heart rate response was maintained in
the thyrotoxic state, although heart rate variability was significantly
increased (p less than 0.001). The prevalence of ventricular premature contractions was not significantly
different before and after treatment, although premature atrial contractions were more
prevalent during the middle third of the day (p less than 0.01) when subjects
were euthyroid. These findings support the view that normal adrenergic
responsiveness persists in hyperthyroidism, and for most individuals treatment does
not significantly alter the prevalence of ectopic activity.



J
Endocrinol Invest. 2007
Mar;30(3):230-5.

Favorable clinical heart and bone effects of anti-thyroid
drug therapy in endogenous subclinical hyperthyroidism.



Buscemi S1, Verga S, Cottone S, Andronico G, D'Orio L, Mannino V, Panzavecchia D, Vitale F, Cerasola G.

Author information

Abstract



Although subclinical hyperthyroidism (SCH) has been associated with
increased risk of osteoporosis and cardiac arrhythmias, its treatment is still
controversial. This study was designed as a prospective, randomized,
intervention, control-study with a 1-year follow-up in order to investigate whether
normalization of serum TSH in SCH using methimazole has favorable bone and
heart clinical effects. Fourteen patients with endogenous SCH (not Graves'
disease) were enrolled, 7 (5 women/2 men; group T) were treated with
methimazole (2.5-7.5 mg/day), and 7 (5 women/2 men; group C) were followed
without treatment; 10 healthy subjects were also included in the study as
controls. Serum free-T3 (FT3), free-T4 (FT4) and TSH, thyroid echography, bone
stiffness index (SI), as measured by heel ultrasonometry, and 24-h
electrocardiography monitoring were obtained. SCH patients exhibited higher
systolic and diastolic blood pressure than control subjects. They also had a
significantly higher number of both ventricular prematurebeats (VPB)
(mean+/-SEM: 681+/-238 vs 6+/-2 beats/24 h; p<0.02) and atrial premature beats (APB) (mean+/-SEM: 495+/-331 vs 7+/-2 beats/24
h; p<0.0001), and a lower SI (66+/-5 vs 96+/-3; p<0.001). Twelve months
after normalization of TSH with the use of methimazole, the number of VPB
decreased significantly (947+/-443 vs 214+/-109 beats/24
h; p<0.05) while it remained unchanged in untreated SCH patients (414+/-163
vs 487+/-152beats/24 h; p=ns). An insignificant
therapy effect was observed as far as APB were concerned (826+/-660 vs 144+/-75 beats/24
h; p=ns), however their number increased significantly in the untreated group
(463+/-49 vs 215+/-46 beats/24 h; p<0.05). The SI increased significantly
as a result of therapy in group T (64.1+/-4.8 vs 70.0+/-5.3; p<0.02) and was
further reduced in group C at the end of the study (69.1+/-7.3 vs 62.9+/-7.1;
p<0.001). No adverse effect was observed in group T. In conclusion,
anti-thyroid therapy seems to have favor-able bone and heart clinical effects
in subjects with endogenous SCH.