digitoxin and Heart-Arrest

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Calcium; Digitalis; Digitalis Glycosides; Digitoxin; Dogs; Electrocardiography; Heart Arrest; Heart Block; Heart Conduction System; Humans; Pharmacology; Potassium; Research; Strophanthins; Toxicology

A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical  improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured.

Topics: Aged; Borago; Digitalis; Electrocardiography; Female; Heart Arrest; Humans; Male; Middle Aged; Plant Poisoning; Severity of Illness Index

Plant poisonings are rare in Denmark, but can have fatal consequences. We present a case in which a woman went into cardiac arrest after having ingested leaves from the foxglove plant. Sinus rhythm was not restored until Digibind was administered. Literature in this field is sparse, but we conclude that the following advice can be given: 1) assessment of the degree of poisoning should be based on clinical features and changes of the electrocardiogram; 2) activated charcoal should be given; 3) in case of malignant arrhythmia or cardiac arrest, the use of Digibind should be considered.

Topics: Digitalis; Electrocardiography; Female; Heart Arrest; Humans; Immunoglobulin Fab Fragments; Immunologic Factors; Middle Aged; Plant Poisoning; Suicide, Attempted; Treatment Outcome

The present study examines the hypothesis that vagal activity can accelerate the onset of cardiac arrest produced by administering a beta-adrenergic blocking dose of propranolol to digitoxin-intoxicated dogs. In 11 experiments, intravenous injection of 0.75 mg/kg propranolol into digitoxin intoxicated dogs induced a sustained ventricular asystole (early-phase cardiac arrest). In six of these eleven experiments, intermittent pacing of the ventricles for as long as 150 min to maintain blood pressure after the onset of asystole, led to the resumption of spontaneous heart beats in only one dog. In five other experiments, injection of atropine (1 mg/kg) three min after the onset of early-phase cardiac arrest elicited sustained spontaneous junctional rhythms. In another four experiments the injection of atropine prior to or simultaneously with propranolol prevented the occurrence of asystole and caused the emergence of a junctional pacemaker. In eight experiments in which the cardiac arrest was reversed or prevented, injection of maintenance doses of atropine and propranolol caused eventual failure of the junctional pacemaker (late-phase cardiac arrest). This failure could not be prevented or reversed by atropine. The results suggest that early-phase cardiac arrest is due to vagal suppression of cardiac pacemakers and therefore supports the above hypothesis.

Topics: Animals; Atropine; Digitoxin; Dogs; Electrocardiography; Female; Heart; Heart Arrest; Male; Propranolol

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Arrhythmia Agents; Cardiac Catheterization; Digitoxin; Electrocardiography; Female; Heart Arrest; Heart Injuries; Heart Valve Diseases; Humans; Hyperkalemia; Male; Middle Aged; Pacemaker, Artificial; Prognosis; Sepsis; Shock, Cardiogenic; Thrombosis; Time Factors; Ventricular Fibrillation

In 22 digitalized (of a total of 39) patients studied at random by radioimmunoassay during cardiac arrest, the mean serum digoxin concentration was 2.6 (+/- 1.86, range 0.6-8.2) ng/ml, significantly higher (P less than 0.001) than the "eudigitalized" concentration (1.3 +/- 0.52, range 0.5-2.3 ng/ml) determined under carefully standardized conditions in a non-toxic population. Half of the arrest patients had serum digoxin levels in the toxic range (2.4 ng/ml or above), mainly due to significant renal failure (mean serum creatinine concentration 2.9 +/- 2.66 v. 1 +/- 0.26 mg/dl for non-toxic subjects, P less than 0.001), partly due to a higher mean daily digoxin dose (0.40 v 0.31 mg/day, P less than 0.05) and frequently associated with potent diuretic therapy (73 v 54%). A smaller fraction of digitalized patients survived, both short- (27%) and long-term (14%), than did non-digitalized subjects (35% and 26%, respectively). The mean myocardial digoxin concentration was 150 (+/- 63.3, range 52-252) ng/g with an average myocardial/serum ratio of 62.5 (range 38-91). There were significant positive correlations between the serum digoxin and left-ventricular myocardial digoxin concentration (r=0.8107, P less than 0.01) or serum creatinine concentration (r=0.4637, P less than 0.001).

Topics: Adult; Aged; Blood Urea Nitrogen; Coronary Disease; Creatinine; Digitoxin; Diuretics; Female; Heart Arrest; Humans; Kidney Diseases; Male; Middle Aged; Myocardium; Time Factors

Topics: Adenosine; Animals; Bradycardia; Bufanolides; Cardiac Glycosides; Cardiac Output; Digitalis Glycosides; Digitoxin; Digoxin; Guinea Pigs; Heart Arrest; Heart Block; Infusions, Parenteral; Lethal Dose 50; Mathematics; Ouabain; Plants, Medicinal; Time Factors

Topics: Adolescent; Cerebral Hemorrhage; Child; Child, Preschool; Digitalis; Electrocardiography; Embolism, Air; Follow-Up Studies; Heart Arrest; Heart Rate; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Infant, Newborn, Diseases; Mortality; Plants, Medicinal; Plants, Toxic; Postoperative Complications; Prognosis; Pulmonary Edema; Statistics as Topic; Stimulation, Chemical; Transposition of Great Vessels

Topics: Acute Disease; Adult; Aged; Anticoagulants; Arrhythmias, Cardiac; Digitoxin; Electrocardiography; Female; Furosemide; Heart Arrest; Heart Block; Heart Massage; Humans; Intensive Care Units; Isoproterenol; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Pacemaker, Artificial; Ventricular Fibrillation

Topics: Adams-Stokes Syndrome; Bradycardia; Digitalis; Digoxin; Electrocardiography; Heart Arrest; Heart Rate; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Quinidine; Sympathomimetics

Topics: Adult; Arrhythmias, Cardiac; Death, Sudden; Digitalis; Electric Countershock; Embolism; Female; Heart Arrest; Heart Diseases; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Popliteal Artery; Quinidine; Ventricular Fibrillation

Topics: Arrhythmias, Cardiac; Blood Volume; Calcium; Carbon Dioxide; Cations; Chlorides; Digitalis; Digitalis Glycosides; Dogs; Drug Synergism; Edetic Acid; Electrocardiography; Heart Arrest; Myocardium; Pacemaker, Artificial; Pharmacology; Potassium; Research; Sodium; Toxicology

Topics: Digitoxin; Guinea Pigs; Heart; Heart Arrest; Metabolism; Pharmacology; Potassium; Research; Sexual Partners; Toxicology

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Arrest; Heart Block; Humans; Myocardial Infarction; Physiology; Sympathomimetics; Ventricular Fibrillation

Topics: Arrhythmias, Cardiac; Digitoxin; Digoxin; Heart Arrest; Humans; Infant

Topics: Digitalis; Digitalis Glycosides; Heart Arrest; Resuscitation; Toxicology

Topics: Arrhythmias, Cardiac; Chlorothiazide; Digitalis; Heart Arrest; Heart Block; Heart Defects, Congenital; Humans; Medical Records; Pacemaker, Artificial

Topics: Animals; Digitalis; Digitalis Glycosides; Digitoxin; Electrocardiography; Heart Arrest; Humans; Plant Extracts; Rats

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Arrest; Myocardium; Sympathomimetics

Topics: Citrates; Digitalis; Elective Surgical Procedures; Heart Arrest; Potassium

Topics: Digitalis; Digitalis Glycosides; Electric Stimulation; Electric Stimulation Therapy; Heart Arrest; Resuscitation; Syncope

Topics: Acetyldigitoxins; Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart Arrest; Heart Failure