The hypothyroid patient has decreased cardiac contractility and presents with increased peripheral vascular resistance, decreased blood volume, decreased cardiac output, decreased heart rate, and decreased pulse pressure.
What are the cardiovascular presentations of hypothyroidism?
The cardiovascular manifestations of hypothyroidism may include bradycardia, a quiet precordium, diastolic hypertension, and a dilated cardiac silhouette on chest x-ray. Patients may have pericardial effusions accounting for the cardiac enlargement. However, worsening congestive heart failure occurs in the hypothyroid state as thyroid hormone deficiency leads to decreased myocardial contractility. Some patients may present with noncardiac chest pain and elevations in creatinine kinase, with elevation of the MM fraction ruling out myocardial infarction. Electrocardiographic (ECG) abnormalities typically include sinus bradycardia, nonspecific ST-T wave abnormalities, and low voltage. Hypothyroidism has been seen in association with ventricular
arrhythmias, including torsade de pointes. Hypothyroid patients have increased prevalence of atherosclerotic heart disease, which may be related to the dyslipidemia accompanying hypothyroidism.
What consideration is needed in hypertensive patients with low potassium?
Excess adrenal mineralocorticoids cause hypertension in 1% of the population. However, they may be implicated when the hypertension is associated with hypokalemia, particularly in the patient who has a high salt intake or may not be taking diuretics.