2302. Thyrotoxicosis and the heart.
Many patients with thyrotoxicosis have clinical features that reflect the effects of excess thyroid hormone on the cardiovascular system. Thyrotoxicosis can aggravate preexisting cardiac disease and can also lead to atrial fibrillation, congestive heart failure, or worsening of angina pectoris. In elderly patients, these cardiac manifestations may dominate the clinical picture and warrant the measurement of the serum thyrotropin concentration. In the absence of preexisting cardiac disease, treatment of thyrotoxicosis usually results in a return of normal cardiac function.
2304. How far to lower blood pressure.2310. Asthma in children.
Despite advances in the understanding of asthma, there is still a high rate of morbidity and mortality from this disease in children. Although many factors are involved, a persistent concern is that the overuse of beta-agonists combined with the underuse of antiinflammatory medications leads to increased mortality. The demonstration that airway inflammation is present in mild asthma and the observations that inflammatory stimuli increase airway responsiveness have led to the use of antiinflammatory agents at earlier stages of disease. However, the medications with antiinflammatory activity that are currently available are not effective for all patients. The problems posed by chronic severe asthma in a child despite appropriate use of corticosteroids suggest that our current concepts are overly simplistic. Therefore, health care workers dealing with this disease must maintain an open mind about what constitutes optimal therapy.
|