digitoxin and Arteriosclerosis

Topics: Adult; Aged; Arteriosclerosis; Body Weight; Clinical Trials as Topic; Diet, Sodium-Restricted; Digitoxin; Diuresis; Electrocardiography; Heart Conduction System; Heart Failure; Humans; Hyperthyroidism; Injections, Intravenous; Middle Aged; Myocardial Infarction

Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 +/- 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 +/- 0.15 (range 0.17-0.84), P less than 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty-eight per cent of patients with congestive heart failure had ejection fractions greater than or equal to 0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term-prognosis is relatively favorable.

Topics: Aged; Arteriosclerosis; Digitalis; Heart Diseases; Heart Failure; Heart Ventricles; Hospitalization; Humans; Plants, Medicinal; Plants, Toxic

This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

Topics: Aged; Arteriosclerosis; Blood Pressure; Blood Volume; Cardiac Output; Coronary Disease; Digitalis; Digoxin; Female; Heart Rate; Humans; Male; Middle Aged; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Preoperative Care; Vascular Surgical Procedures

Sleep problems of the aging differ from adolescents clinicaly as well as in their EEG-pattern. They can be purely functional (exogenous or reactiv) however are frequently influenced by changes in the aging organism. Most common are cardio-vascular and pulmonary problems. The treatment of sleep disorders has to emphasize the improvement of these problems so that functional sleep difficulties can be treated successfully. It has to be recognized that elderly people can react paradoxically or overreact to all psychotropic agents including hypnotics.

Topics: Aged; Antidepressive Agents; Arteriosclerosis; Brain; Digitoxin; Disorders of Excessive Somnolence; Drug Synergism; Ethanol; Humans; Psychotropic Drugs; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Strophanthins

In summary, a prognostic and therapeutic evaluation of 227 patients first seen from 1967 to the end of 1969 with a follow-up of 4-7 years was made. The results are indeed depressing. In spite of close follow-up and systematic treatment with modern antihypertensive agents, the mortality of patients having hypertension with superimposed arteriosclerosis was 27% (15 to 56) for males as contrasted to 3% (2 of 75) for females. Since the last casual blood pressure in both living and deceased patients of the mixed group were similar, the level of blood pressure following treatment could not be incriminated for the deceased patients. An exaggerated systolic and pulse pressure cold pressor response emerged as an important indicator of presence of arteriosclerosis alone. When hypertension and arteriosclerosis coexisted there was also exaggeration in diastolic cold pressor response. A further exaggeration in systolic and diastolic cold pressor response was seen in the decreased as compared to living male patients, a finding which appears to have grave prognostic significance for coronary heart disease and stroke. Thus a marked exaggeration in both systolic and diastolic cold pressor response in males might prove to be the single most important predictor of premature death from atherosclerotic vascular disease. A further analysis of the deceased male patients having hypertension and superimposed arteriosclerosis, indicates that treatment of hypertension may prevent oeath from stroke but not form coronary heart disease. Two-thirds of the deaths occur suddenly and only one-third of the deceased patients reached the hospital befor dying. In view of these distressing findings a plea for early detection and treatment of hypertension, prior to the development of superimposed arteriosclerotic changes, particularly in males, is made.

Topics: Arteriosclerosis; Blood Pressure; Cold Temperature; Digitalis; Female; Follow-Up Studies; Humans; Hydralazine; Hypertension; Male; Plants, Medicinal; Plants, Toxic; Private Practice; Prognosis; Reserpine; Sex Factors; Spironolactone; Statistics as Topic

Topics: Acetyldigitoxins; Arteriosclerosis; Atrial Fibrillation; Coronary Disease; Digitoxin; Geriatrics; Heart Failure; Humans; Hypertension; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia

Topics: Arrhythmias, Cardiac; Arteriosclerosis; Digitalis; Digitalis Glycosides; Electrocardiography; Geriatrics; Heart Failure; Toxicology

Topics: Aortic Diseases; Aortic Valve Stenosis; Arteriosclerosis; Digitalis; Digitalis Glycosides; Glucosephosphates; Heart Failure; Hexosephosphates; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pulmonary Heart Disease

Topics: Arteriosclerosis; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Geriatrics; Gynecomastia; Humans; Male; Mastectomy; Mitral Valve Insufficiency; Pathology; Rheumatic Heart Disease; Toxicology

Topics: Arteriosclerosis; Digitalis; Digitalis Glycosides; Lanatosides; Plant Extracts