Heart Failure in Addison's Disease with Myocardial Changes of Potassium Deficiency

THE hearts of persons dying of Addison's disease usually show no pathologic change beyond small size and brown atrophy. Clinically, however, it is well recognized that patients suffering with severe adrenal cortical deficiency have very poor cardiac reserve. They suffer dyspnea upon mild exertion. Electrocardiographic evidence of myocardial damage is present in a large percentage of cases (1, 2). In untreated Addison's disease the weakened state of the myocardium may be due to one or more of a number of factors. Among these must be considered: a) lack of a specific influence of one or more cortical hormones directly upon the myocardium; b) hemo-concentration; c) low blood volume and perhaps consequent poor coronary flow; d) poor alimentation and exhausted glycogen reserves; and e) disturbances in electrolyte balance. The usual circulatory collapse in Addisonian crisis is characterized by extreme dehydration and a falling blood pressure. The changes in electrolytes as reflected in the serum reveal low sodium and chloride and high potassium.