digitoxin and Cardiomyopathies

Patients with chronic renal failure develop a cardiomyopathy characterized by marked diastolic dysfunction and left ventricular hypertrophy. Interestingly, they also have substantial increases in the circulating concentrations of digitalis like substances. Digitalis like substances produce reactive oxygen species as part of the signal cascade induced by binding to the sodium pump and patients, and this signal cascade appears to induce hypertrophy of cardiac myocytes grown in culture. Also, patients with chronic renal failure develop an oxidant stress state without a known mechanism. From these data, we propose that it is these digitalis like substances which cause cardiomyopathy of renal failure as well as the systemic oxidant stress state.

Topics: Cardenolides; Cardiomyopathies; Digitalis; Humans; Kidney Failure, Chronic; Saponins; Uremia

It is well known that the nutritional deficiency possibly causes cardiac dysfunction. Although social hygiene has successfully diminished these cardiac dysfunction in developed countries, patients could be found in certain number under altered clinical profiles than before. Excess intake of carbohydrate drinks and carbohydrates should make beri-beri heart in youth. Not only deficiency but recent dietary habits of excessive nutrition in these developed countries are causing new types of nutritional cardiac dysfunctions such as obesity cardiomyopathy in morbid obese. On the other hand, anorexia nervosa which sometimes shows heart failure and sudden death combines with psychosomatic disorders. In this article, the pathogenesis and treatments are discussed focusing on these three cardiac disorders.

Topics: Anorexia Nervosa; Beriberi; Cardiomyopathies; Diagnosis, Differential; Digitalis; Humans; Nutrition Disorders; Obesity; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Thiamine

Congestive heart failure (CHF) due to idiopathic cardiomyopathy is reviewed. CHF in dilated cardiomyopathy (DCM) is caused mainly by myocardial systolic dysfunction. Diuretics, angiotensin-converting enzyme (ACE) inhibitors and digitalis are the first choice drugs. ACE inhibitors have been shown to be effective in prolonging life and improving quality of life. Recently, long-term beta-blockade therapy has been shown to be useful. CHF in hypertrophic cardiomyopathy (HCM) is caused by decreased myocardial compliance. The beneficial effect of verapamil in HCM is related to improved relaxation and diastolic filing. Verapamil is also effective in relieving myocardial ischemia. Beta-blockade decreases pressure gradient and oxygen consumption. Idiopathic restrictive cardiomyopathy is a very rare disease and decreased myocardial compliance is responsible for CHF.

Topics: Adrenergic beta-Antagonists; Calcium Channel Blockers; Cardiomyopathies; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Animals; Cardiomyopathies; Catecholamines; Cattle; Cobalt; Digitoxin; Disease Models, Animal; Dogs; Humans; Male; Myocarditis; Rabbits; Rats; Steroids; Virus Diseases; Vitamin B Deficiency

Sarcoidosis is a multisystemic disorder that may involve every organ. A symptomatic manifestation of the myocardium is possible, in these cases arrhythmias are the most common symptoms.. This case report presents a 26-year-old female with the recurrence of Boeck's sarcoid. Fever, chill and a severe reduction in stress tolerance were the first symptoms. At the time of admission she complained of Grade III dyspnea according to the NYHA classification. The echocardiogram showed a severe impairment of the global and left ventricular function. The left ventricular ejection fraction was reduced to 30% and the Tei index was elevated to 1.0. A specimen taken from a mediastinal tumor confirmed the hypothesis of the recurrence of the sarcoidosis. Myocardial perfusion scintigraphy showed typical lesions for myocardial sarcoidosis. There were signs of an old anteroseptal infarction in the resting ECG without evidence of myocardial ischemia during a stress test. Repeated Holter-ECGs were without signs of severe arrhythmias whereas ventricular late potentials were positive. After the combined therapy with steroids, digitalis and an angiotensin-1 receptor antagonist, mediastinal mass and Tei index were reduced and the ejection fraction moved to 56%. Dyspnoea was classified with Grade II according to the NYHA classification.. Treatment of asymptomatic sarcoidosis is still controversial, whereas the treatment of life-threatening sarcoidosis, eye involvement or severe hypercalcemia is accepted. This case report presents the successful treatment of severe heart failure with prednisone, glycosides and an angiotensin-1 receptor antagonist. With this combined therapy an improvement of subjective and objective parameters was possible.

Topics: Adult; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Cardiomyopathies; Digitoxin; Drug Therapy, Combination; Female; Heart Failure; Humans; Losartan; Prednisone; Sarcoidosis; Ultrasonography

Catecholamine-induced cardiomyopathy is a rare complication of pheochromocytoma. We present a case of pheochromocytoma that developed preoperative heart failure. Left ventricular dilation and severe hypokinesia were demonstrated by echocardiography. Heart failure was successfully treated with digitalis, diuretics and captopril. There were no surgical complications and the follow up showed and improvement on the systolic function evaluated by echocardiography and isotope ventriculography, 3 and 6 months after surgery. We review the pathophysiology and evolution of catecholamine induced cardiomyopathy. Preload reserve can be one of the adaptive mechanisms of the ventricle in catecholamine-induced cardiomyopathy. Conventional therapy of hypertension and heart failure can be effective to correct the symptoms of cardiac dysfunction.

Topics: Adrenal Gland Neoplasms; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cardiomyopathies; Catecholamines; Digitalis; Diuretics; Echocardiography; Follow-Up Studies; Furosemide; Heart Failure; Humans; Male; Middle Aged; Pheochromocytoma; Plants, Medicinal; Plants, Toxic; Time Factors

Cardiac dysfunction is common in patients with terminal renal failure. However, no consensus has been reached with respect to the indications for digitalis therapy. Depression of myocardial contractility may occur as a result of circulating toxic factors, parathyroid hormone, and altered catecholaminergic responsiveness. On the other hand, paradoxical positive inotropic effects have been observed possibly as a result of a circulating natriuretic factor (an endogenous digitalis analogue) which inhibits Na,K-ATP'ase. Pharmacokinetics and pharmacodynamics of digitalis steroids are altered in uremia. Elimination half-lives of strophanthin and digoxin are prolonged, whereas the elimination half-life of digitoxin is unchanged. Altered protein binding and volume of distribution have been noted. Despite its long elimination half-life, most nephrologists favor administration of digitoxin because of its insensitivity to changes in renal function.

Topics: Animals; Biological Availability; Blood; Blood Proteins; Cardenolides; Cardiomyopathies; Cats; Digitalis; Digitoxin; Digoxin; Dogs; Dose-Response Relationship, Drug; Guinea Pigs; Humans; Kidney Failure, Chronic; Kinetics; Metabolic Clearance Rate; Myocardial Contraction; Peritoneal Dialysis, Continuous Ambulatory; Plants, Medicinal; Plants, Toxic; Rabbits; Rana temporaria; Rats; Renal Dialysis; Saponins; Sodium-Potassium-Exchanging ATPase; Stimulation, Chemical; Ultrafiltration; Uremia

Although therapy of congestive heart failure has to remain symptomatic in many cases, diagnostic evaluation should always precede initiation of therapy. Goals are (1) improvement of contractility (digitalis; other positive inotropic substances are in evaluation) and (2) decrease of preload and afterload by diuretics and vasodilators. Those therapeutic principles are briefly discussed. Symptomatic therapy certainly improves quality of life, but it remains unclear whether survival is improved as well.

Topics: Cardiomyopathies; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Time Factors; Vasodilator Agents

The treatment of congestive cardiomyopathy is dependent on clinical findings, reduced ejection fraction and presence of congestion. Diet, digitalis and vasodilator drugs: prazosin or dihydralazine are used in congestive cardiomyopathy class I or II (NYHA). In the presence of congestion diuretics are added, in chronic congestion of the lung nitrate. Congestive cardiomyopathy class III or IV (NYHA) is treated with diet, digitalis and the converting enzyme inhibitor captopril. In the therapy of HOCM or HNCM the calcium antagonist verapamil is now widely used and seems to be replacing the beta-blocker treatment with propranolol. If treatment with beta-blocker and calcium antagonists in patients with HOCM class III or IV (NYHA) ist ineffective surgical therapy is necessary.

Topics: Adrenergic beta-Agonists; Anti-Arrhythmia Agents; Anticoagulants; Captopril; Cardiac Glycosides; Cardiomyopathies; Diet, Sodium-Restricted; Digitoxin; Digoxin; Dihydralazine; Diuretics; Humans; Nitrates; Practolol; Prenalterol; Temperance; Vasodilator Agents; Verapamil

Topics: Cardiomyopathies; Digitalis; Dopamine; Humans; Plants, Medicinal; Plants, Toxic

Topics: Administration, Oral; Adolescent; Adult; Age Factors; Aged; Antigen-Antibody Reactions; Body Weight; Cardiomyopathies; Creatinine; Digitoxin; Humans; Immune Sera; Kidney Failure, Chronic; Methods; Middle Aged; Nephrotic Syndrome; Radioimmunoassay; Serum Albumin

Topics: Acetyldigitoxins; Adult; Aged; Angina Pectoris; Azepines; Benzoates; Cardiomyopathies; Digitoxin; Drug Combinations; Female; Hospitals, Special; Humans; Male; Middle Aged; Vasodilator Agents

Topics: Adrenal Gland Neoplasms; Adult; Angiography; Cardiomyopathies; Catecholamines; Digitalis; Electrocardiography; Heart; Humans; Hypertension; Iodine Radioisotopes; Kidney; Male; Organomercury Compounds; Pheochromocytoma; Phytotherapy; Plants, Medicinal; Plants, Toxic; Posture

Topics: Adult; Aged; Arrhythmias, Cardiac; Cardiomyopathies; Digitalis; Digitalis Glycosides; Fatty Acids, Nonesterified; Female; Glycerol; Humans; Hypertension; Lactates; Male; Middle Aged; Plant Extracts; Plants, Medicinal; Plants, Toxic

Topics: Alcohol Drinking; Anticoagulants; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diet, Sodium-Restricted; Digitalis; Digoxin; Diuretics; Ethanol; Female; Heart; Heart Failure; Humans; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Practolol; Pregnancy; Propranolol; Rest

Topics: Adult; Age Factors; Angiography; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Cardiomyopathies; Coronary Disease; Digitalis; Exercise Test; Female; Heart Diseases; Heart Rate; Heart Valve Diseases; Hemodynamics; Humans; Hypoxia; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Statistics as Topic; Tachycardia; Ventricular Fibrillation

Topics: Aged; Atrial Fibrillation; Cardiomyopathies; Diagnosis, Differential; Digitalis; Electrocardiography; Geriatrics; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Ischemia; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic; Ventricular Fibrillation

Topics: Acidosis; Adult; Alcoholism; Beriberi; Blood Gas Analysis; Blood Pressure; Cardiac Output; Cardiomyopathies; Cyanosis; Diagnosis, Differential; Digitoxin; Electrocardiography; Heart Failure; Heart Rate; Humans; Hyperventilation; Lactates; Male; Morphine; Oxygen; Oxygen Consumption; Pyruvates; Respiration; Thiamine; Vascular Resistance

Topics: Animals; Cardiomyopathies; Desoxycorticosterone; Digitoxin; Disease Models, Animal; Ethylestrenol; Female; Fludrocortisone; Myocardial Infarction; Necrosis; Norsteroids; Oxandrolone; Perchlorates; Prednisolone; Progesterone; Rats; Sodium; Spironolactone; Steroids; Triamcinolone

Topics: Animals; Cardiomyopathies; Digitoxin; Enzyme Induction; Heart; Microscopy, Electron; Myocardium; Necrosis; Oils; Phosphates; Rats; Sodium; Spironolactone

Topics: Animals; Cardiomyopathies; Digitoxin; Female; Heart; Microscopy, Electron; Mitochondria, Muscle; Myocardium; Rats; Swimming

Topics: Alkaline Phosphatase; Animals; Calcium; Cardiomyopathies; Digitoxin; Electron Transport Complex IV; Female; Glucosyltransferases; Glycogen; Histocytochemistry; Hypoxia; Lipid Metabolism; Necrosis; Oils; Papillary Muscles; Phosphates; Rats; Succinate Dehydrogenase; Water-Electrolyte Balance

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Azathioprine; Cardiomyopathies; Digitoxin; Heart Transplantation; Heart Valve Diseases; Histocompatibility; Humans; Hydrocortisone; Hydroquinones; Male; Methods; Phlebitis; Postoperative Complications; Serum Globulins; Transplantation, Homologous

Topics: Animals; Cardiomyopathies; Digitoxin; Drug Synergism; Enzyme Induction; Female; Heart; Injections, Subcutaneous; Liver; Myocardial Infarction; Myocardium; Necrosis; Phosphates; Rats; Spironolactone; Triamterene

Topics: Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Cardiomyopathies; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Poisoning

Topics: Cardiomyopathies; Depression; Digitalis; Disease; Electrocardiography; Heart Diseases; Humans; Myocardium