Death in Myxoedema Coma

Abstract

The prevailing opinion appears to be that pericardial effusion is only rarely a contributory factor in causing en- largement of the "myxoedema heart."Kern et al. (1949).describe four consecutive, cases of their own in which an effusion was proved by a pericardial tap and air replace- ment, and they maintain that pericardial effusion is the commonest cause of cardiac enlargement in myxoedema.Cases of myxoedema with dropsy have been recorded by Mussio-Fournier (1925).Mussio-Fournier et al. (1946) have reported one case which also had a pericardial effusion, but they hold that an effusion is a minor factor in the enlarged " myxoedema heart."Bullrich (quoted by Mussio-Fournier et al., 1946) is of the same opinion.The heart diminishes rapidly with adequate doses of thyroid extract unless another form of heart disease is also present.It is evident that there is usually no true hypertrophy, the enlargement being due to a pericardial effusion or perhaps myxoedema of the heart muscle.Coronary atheroma may be present, due to the high blood cholesterol.Digitalis is not indicated.Congestive failure is relatively rare in " myxoedema heart."In my case the heart decreased in size considerably, but it did not return to normal, probably owing to the associated hypertension.There was no evidence that the patient's anasarca was due to hypertensive cardiac failure, in that her symptoms and the oedema were completely relieved by thyroid therapy only, and she was well and without signs of heart failure up to the time of writing.The effusions were due to heart failure caused by the myxoedema.