digitoxin and Heart-Diseases

Digitalis has been an old but reliable drug for 240 years. Concerns regarding its clinical indications and benefits still exist in the absence of a reduction in all-cause mortality. While intravenous digitalis is used without question in cases of atrial fibrillation, it is still controversial in sinus rhythm, despite the Digitalis Investigation Group (DIG) study showing a significant reduction in death and the need for hospitalisation for congestive heart failure in both diastolic and systolic dysfunction. The influence of digitalis in acute myocardial infarction, coronary artery disease and sudden cardiac death remains speculative. In cases of uncomplicated hypertension, it appears to prevent the onset of left ventricular dysfunction and myocardial infarction. Thus, digitalis can be a cost-effective agent with added benefits.

Topics: Anti-Arrhythmia Agents; Arrhythmia, Sinus; Coronary Disease; Digitalis; Heart Diseases; Heart Failure; Humans; Hypertension; Phytotherapy; Plants, Medicinal; Plants, Toxic

The authors consider the ever-increasing number of depressed patients, related to the stress of modern life and to the prolongation of life span. They stress that these patients are often cardiopathic or impaired by the senile heart. Finally they illustrate the cardiovascular effects of antidepressant drugs and how to avoid them.

Topics: Aged; Animals; Anti-Arrhythmia Agents; Antidepressive Agents; Antidepressive Agents, Tricyclic; Arrhythmias, Cardiac; Cardiovascular System; Depression; Digitalis; Drug Interactions; Heart Diseases; Heart Rate; Humans; Hypotension; Plants, Medicinal; Plants, Toxic

Knowledge-based expert systems for medical applications have received considerable attention in recent years. In this review, fundamental terms and notions of artificial intelligence techniques as applied to expert systems are introduced. The most well-known and influential medical expert systems are discussed in detail, and newer efforts are surveyed. A critical comparison of strengths and weaknesses of the systems is made, discussing depth and complexity of knowledge, acquisition of knowledge, user interaction and explanations, knowledge engineering tools, system evaluations, and user resistance. Long- and short-term trends are appraised.

Topics: Cholestasis; Diagnosis, Computer-Assisted; Digitalis; Edema; Glaucoma; Heart Diseases; Humans; Infections; Information Systems; Lung Diseases; Plants, Medicinal; Plants, Toxic; Software

Topics: Adrenergic beta-Antagonists; Aged; Aging; Atrial Fibrillation; Cardiovascular Physiological Phenomena; Digitalis; Diuretics; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Heart; Heart Block; Heart Diseases; Humans; Hypertension; Mitral Valve; Plants, Medicinal; Plants, Toxic; Potassium Deficiency; Risk

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Diagnosis, Differential; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Heart Rate; Heart Ventricles; Humans; Myocardium; Poisoning; Radioimmunoassay

Topics: Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Glomerular Filtration Rate; Heart Diseases; Humans; Kinetics; Lanatosides

Topics: Age Factors; Aged; Angina Pectoris; Arrhythmias, Cardiac; Bundle-Branch Block; Digitalis; Electrocardiography; Female; Heart Diseases; Heart Failure; Hemodynamics; Humans; Hypertension; Male; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Prognosis

Topics: Administration, Oral; Animals; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Catheterization; Cardiac Surgical Procedures; Coronary Disease; Depression, Chemical; Digitalis; Digoxin; Heart; Heart Diseases; Humans; Injections, Intravenous; Ouabain; Phenytoin; Plants, Medicinal; Plants, Toxic; Ventricular Fibrillation

Topics: Animals; Antibody Formation; Antibody Specificity; Binding Sites, Antibody; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Immune Sera; Rabbits; Radioimmunoassay

Topics: Aspartic Acid; Bufanolides; Cardanolides; Cardiac Glycosides; Digitoxin; Digoxin; Heart; Heart Diseases; Humans; Khellin; Lanatosides; Nitrites; Plants, Medicinal; Procainamide; Quinidine; Strophanthins; Sympatholytics; Sympathomimetics; Vasodilator Agents

Topics: Anesthesia; Animals; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiac Surgical Procedures; Cardiovascular System; Central Nervous System; Digitalis; Dogs; Heart; Heart Diseases; Heart Failure; Humans; Parasympatholytics; Phenytoin; Plants, Medicinal; Plants, Toxic; Procaine; Quinidine

Topics: Child; Digitalis; Digitalis Glycosides; Drug Therapy; Heart Diseases; Humans; Infant; Infant, Newborn; Toxicology

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart; Heart Diseases; Humans; Pharmacology

We determined in vitro the potency of macrolides as P-glycoprotein inhibitors and tested in hospitalised patients whether coadministration of P-glycoprotein inhibitors leads to increased serum concentrations of the P-glycoprotein substrates digoxin and digitoxin.. In vitro, the effect of macrolides on polarised P-glycoprotein-mediated digoxin transport was investigated in Caco-2 cells. In a pharmacoepidemiological study, we analysed the serum digoxin and digitoxin concentrations with and without coadministration of P-glycoprotein inhibitors in hospitalised patients.. All macrolides inhibited P-glycoprotein-mediated digoxin transport, with concentrations producing 50% inhibition (IC(50)) values of 1.8, 4.1, 15.4, 21.8 and 22.7 micromol/L for telithromycin, clarithromycin, roxithromycin, azithromycin and erythromycin, respectively. Coadministration of P-glycoprotein inhibitors was associated with increased serum concentrations of digoxin (1.3 +/- 0.6 vs 0.9 +/- 0.5 ng/mL, p < 0.01). Moreover, patients receiving macrolides had higher serum concentrations of cardiac glycosides (p < 0.05).. Macrolides are potent inhibitors of P-glycoprotein. Drug interactions between P-glycoprotein inhibitors and substrates are likely to occur during hospitalisation.

Topics: Aged; Aged, 80 and over; Alanine Transaminase; Aspartate Aminotransferases; ATP Binding Cassette Transporter, Subfamily B, Member 1; Bilirubin; Biological Transport; Caco-2 Cells; Creatinine; Digitoxin; Digoxin; Drug Interactions; Erythromycin; Female; Heart Diseases; Humans; Inpatients; Inulin; Ketolides; Macrolides; Male; Pharmacoepidemiology

Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication.. Twenty-nine children with intoxication due to digoxin (28) or digitoxin (1) received Fab at 21 participating hospitals between 1974 and 1986. Data were gathered about the patients' medical illnesses, doses and serum concentrations of digitalis, responses to Fab therapy, and outcomes.. In the infants and young children with acute digoxin intoxication, the digoxin doses ranged from 0.30 to 0.96 mg per kilogram of body weight; two adolescents had severe intoxication after doses of only 0.20 and 0.26 mg per kilogram. The serum digoxin concentrations ranged from 3.0 to greater than 100 ng per milliliter (mean, 13.8). Atrioventricular block (present in 22 patients [76 percent]) was the most common sign of toxicity. All the patients in this series had severe disturbances of cardiac rhythm, hyperkalemia (mean serum potassium concentration, 5.4 mmol per liter), or both. In 27 patients (93 percent), digitalis toxicity resolved after the administration of Fab. Of the 19 patients for whom data were available on the timing of the response to Fab, 15 responded within 180 minutes. Three patients required retreatment with Fab. Seven died of complications unrelated to the administration of Fab.. We recommend that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than or equal to 6.4 nmol per liter (greater than or equal to 5.0 ng per milliliter) in the elimination phase; and who also have a life-threatening arrhythmia, hemodynamic instability, hyperkalemia, or rapidly progressive toxicity. Adolescents, who are more sensitive to the toxic effects of digoxin than younger children, may require treatment with Fab after ingesting lower doses.

Topics: Acute Disease; Adolescent; Arrhythmias, Cardiac; Child, Preschool; Digitoxin; Digoxin; Female; Heart Block; Heart Diseases; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Infant; Infant, Newborn; Male; Poisoning

To determine whether verapamil, diltiazem, or nifedipine affect digitoxin kinetics, glycoside plasma concentrations and renal excretion were measured before and during steady-state dosing in 30 patients with cardiac insufficiency. The mean (+/- SD) digitoxin plasma concentration was 14.27 +/- 3.66 ng/ml before and 18.15 +/- 5.33 ng/ml during verapamil dosing in 10 patients over a period of 4 to 6 weeks. Renal digitoxin clearance was not influenced by verapamil, but total body clearance and extrarenal clearance of digitoxin were reduced by 27% and 29%, respectively. Diltiazem resulted in a 6% to 31% (mean = 21%) increase in plasma digitoxin concentrations in five of 10 patients because of reduced extrarenal clearance of digitoxin. In contrast to verapamil, the concomitant dosing of nifedipine over 4 to 6 weeks did not alter digitoxin plasma levels or daily renal excretion. Based on these observations, the risk of digitalis intoxication after combined dosing with verapamil and digitoxin is much less pronounced than that after digoxin, and thus this glycoside is a valuable alternative.

Topics: Aged; Benzazepines; Clinical Trials as Topic; Digitoxin; Diltiazem; Drug Interactions; Drug Therapy, Combination; Female; Heart Diseases; Humans; Kidney; Kidney Diseases; Kinetics; Liver Diseases; Male; Middle Aged; Nifedipine; Radioimmunoassay; Verapamil

Topics: Adrenergic beta-Antagonists; Aged; Clinical Trials as Topic; Digitoxin; Drug Therapy, Combination; Heart Diseases; Humans; Middle Aged; Vasodilator Agents

A comparison was made of the time of onset and duration of labour in 22 women taking digitalis and in 64 women who were not. Spontaneous labour occurred more than one week earlier and lasted about half as long in the patients taking digitalis. The likely explanation for this difference is that digitalis has a direct action on the myometrium.

Topics: Apgar Score; Birth Weight; Body Height; Digitalis; Female; Gestational Age; Heart Diseases; Humans; Labor, Obstetric; Maternal Age; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pregnancy; Pregnancy Complications, Cardiovascular; Time Factors; Uterus

Topics: Age Factors; Aged; Blood Pressure; Body Weight; Clinical Trials as Topic; Digitoxin; Female; Headache; Heart Diseases; Heart Rate; Heart Valve Diseases; Humans; Ischemia; Male; Middle Aged; Myocardial Infarction; Nausea; Pulmonary Heart Disease; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Aged; Blood Cell Count; Clinical Trials as Topic; Digitoxin; Diuretics; Female; Heart Diseases; Humans; Male; Methods; Middle Aged; Quinidine; Thrombocytopenia

Topics: Clinical Trials as Topic; Coronary Disease; Digitoxin; Digoxin; Electrocardiography; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Strophanthins

Accidental ingestion of foxglove (Digitalis purpurea) can cause significant cardiac toxicity. We report a patient who ingested foxglove mistaking it for comfrey and developed refractory ventricular arrhythmias. The patient died despite treatment with digoxin-specific antibody fragments (DSFab) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).. A 55-year-old woman presented to the emergency department with nausea, vomiting and generalized weakness eight hours after drinking "comfrey" tea. She had bradycardia (54 beats/min) and hyperkalemia (7.6 mEq/L). Electrocardiogram revealed a first-degree atrioventricular conduction block with premature atrial contractions, followed by polymorphic ventricular tachycardia three hours after arrival. A serum digoxin level was 151.2 ng/mL. The patient developed ventricular fibrillation while waiting for Digibind infusion. Resuscitation was performed and an emergent VA-ECMO was set up. A total of eight vials of Digibind were given over the next 16 hours. She temporarily regained consciousness, but remained hemodynamically unstable and subsequently developed lower limb ischemia and multiple organ failure, and she expired on hospital day seven. A botanist confirmed that the plant was foxglove.. The diagnosis of cardiac glycoside plant poisoning can be difficult in the absence of an accurate exposure history. In facilities where DSFab is unavailable or insufficient, early VA-ECMO might be considered in severely cardiotoxic patients unresponsive to conventional therapy.

Topics: Accidents; Cardiac Glycosides; Cardiotoxicity; Comfrey; Digitalis; Electrocardiography; Extracorporeal Membrane Oxygenation; Fatal Outcome; Female; Heart Diseases; Humans; Immunoglobulin Fab Fragments; Middle Aged; Plant Poisoning; Predictive Value of Tests; Resuscitation; Time Factors; Treatment Outcome

Topics: Digitalis; Digitalis Glycosides; Evidence-Based Medicine; Heart Diseases; History, 20th Century; History, 21st Century; Humans; Practice Guidelines as Topic

For centuries, drugs that increase the power of contraction of the failing heart have been used for the treatment of congestive heart failure (dropsy). The cardiac effect is due to the content of cardiac glycosides. Squill or sea onion, Urginea (Scilla) maritima, a seashore plant, was known by the ancient Romans and Syrians and possibly also by the ancient Egyptians. Squills were used erratically, but some prescriptions indicate that they may have been used for the treatment of oedematous states. The toxic effect of strophanthus species was known from poisoned arrows used by the natives in Africa. Digitalis, derived form the foxglove plant, Digitalis purpurea, is mentioned in writings as early as 1250; a Welsh family, known as the Physicians of Myddvai, collected different herbs and digitalis was included in their prescriptions. However, the druge was used erratically until the 18th century, when William Withering, an English physician and botanist, published a monograph describing the clinical effects of an extract of the foxglove plant. Later, in 1785, the indication and the toxicity of digitalis were reported in his book, "An account of the Foxglove and some of its medical uses with practical remarks on dropsy, and other diseases". In Denmark, the leaves of Digitalis purpurea or Digitalis lanata were tested for cardiac glycoside activity. The standardized digitalis powder was used in tinctures, infusions, and tablets. The preparations were included in successive editions of the Danish pharmacopoeia, some of the tinctures already in 1828, i.e. before the standardization of the drug. Isolation of cardiac glycosides from digitalis, strophanthus and squill and determination of their chemical structures initiated biochemical and pharmacological studies. The scientific advances led to an understanding of cardiac muscle contractility and the Na,K pump as the cellular receptor for the inotropic action of digitalis. Examination of putative endogenous ligands to the receptor revealed some endogenous cardiac glycosides of similar or identical structures as those found in digitalis, strophanthus and squill. Increased concentrations of these glycosides are found in patients with heart failure. Further investigations are needed to determine whether the secretion of glycosides might be a physiologic response to a diminished cardiac output.

Topics: Digitalis; Drug Therapy; Glycosides; Heart Diseases; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval

Topics: Cardiotonic Agents; Digitalis; Heart Diseases; History, 20th Century; Humans; Phytotherapy; Plant Extracts; Plants, Medicinal

A 61-year-old man suffering from histologically confirmed amyloidosis associated with coagulation disturbances presented with exercise induced shortness of breath and symptoms of cardiac asthma after four cycles of chemotherapy with melphalan and prednisolone. As a result, treatment with digitoxin was initiated. In addition furosemide and an oral nitrate were administered.. Disparity between electrocardiogram and echocardiographic findings was observed in that, while the electrocardiogram showed loss of 'R wave in precordial leads V(2 - 4), excessive thickening of both left and right ventricular wall was shown in the echocardiogram. Doppler-echocardiography revealed a left ventricular outflow tract obstruction at rest with a peak pressure gradient of 64 mm Hg which rose to 145 mm Hg during Valsalva manoeuvre. Colour Doppler presented a moderate mitral insufficiency and the transmitral Doppler flow studies detected a restrictive left ventricular filling pattern.. Digitalis therapy was stopped because of the outflow tract obstruction complicating cardiac amyloidosis. Cardiac symptoms abated over the following weeks. This improvement was reflected in a significant reduction of the outflow tract gradient, the gradients now being 16 mm Hg under resting conditions and a maximum of 36 mm Hg during the Valsalva manoeuvre. The transmitral Doppler flow pattern showed a pseudonormalisation and the mitral regurgitation regressed nearly completely. The patient was free from cardiac complaints until his sudden death 21 months after the diagnosis of cardiac amyloidosis.. Cardiac amyloidosis can present with left ventricular outflow tract obstruction mimicking hypertrophic obstructive cardiomyopathy. This fact must be borne in mind to avoid therapy with preload-reducing or positive inotropic drugs and especially glycosides.

Topics: Amyloidosis; Asthma, Exercise-Induced; Cardiotonic Agents; Digitoxin; Diuretics; Echocardiography, Doppler, Color; Electrocardiography; Furosemide; Heart Diseases; Humans; Male; Middle Aged; Vasodilator Agents

Digitoxin induces apoptosis in different human malignant cell lines in vitro. In this paper we investigated if patients taking digitoxin for cardiac disease have a different cancer incidence compared to the general population.. Computer stored data on digitoxin concentrations in plasma from 9271 patients with cardiac disease were used to define a user population. Age and sex matched controls from the Norwegian Cancer Registry were used to calculate the number of expected cancer cases.. The population on digitoxin showed a higher incidence of cancer compared to the control population. However, an additional analysis showed that the population on digitoxin had a general increased risk of cancer already, before the start on digitoxin. Leukemia/lymphoma were the cancer types which stood out with the highest risk in the digitoxin population before starting on digitoxin. This indicates that yet unknown risk factors exist for cardiovascular disease and lymphoproliferative cancer. An internal dose-response analysis revealed a relationship between high plasma concentration of digitoxin and a lower risk for leukemia/lymphoma and for cancer of the kidney/urinary tract.. Morbidity and mortality are high in the population on digitoxin, due to high age and cardiac disease. These factors disturb efforts to isolate an eventual anticancer effect of digitoxin in this setting. Still, the results may indicate an anticancer effect of digitoxin for leukemia/lymphoma and kidney/urinary tract cancers. Prospective clinical cancer trials have to be done to find out if digitoxin and other cardiac glycosides are useful as anticancer agents.

Topics: Age Factors; Aged; Anti-Arrhythmia Agents; Case-Control Studies; Cohort Studies; Digitoxin; Dose-Response Relationship, Drug; Female; Heart Diseases; Humans; Incidence; Male; Neoplasms

Topics: Digitalis; Heart Diseases; Humans; Lanatosides; Liver Diseases; Liver Diseases, Alcoholic; Plants, Medicinal; Plants, Toxic; Time Factors; Virus Diseases

Quinidine syncope and factors associated with it are well known among adult patients treated for cardiac arrhythmias. To define factors that may influence the occurrence of syncope in children taking quinidine, the clinical, anatomic, electrocardiographic, roentgenographic and pharmacologic data were compared in six patients with syncope (Group A) and 22 patients without syncope (Group B). There was a significant (chi-square = 10.2, p = 0.001) relation between heart disease and quinidine syncope: all six Group A (syncopal) patients had heart disease whereas 15 of the 22 Group B (non-syncopal) patients had no structural heart disease. In contrast, no significant difference was noted between Group A and Group B patients in mean age (11.4 versus 11.4 years), mean quinidine serum concentration (2.9 versus 2.3 micrograms/ml), mean corrected QT interval before quinidine (0.43 versus 0.40 second) or mean corrected QT interval during quinidine therapy (0.46 versus 0.46 second) or between those taking digitalis and those not. Two of the six Group A (syncopal) patients died during therapy, one 6 days after initiating therapy and one suddenly at home 6 months after beginning quinidine. Another two of the six Group A patients exhibited hypokalemia (both 2.9 mEq/liter) at the time of syncope, 2 weeks and 6 months, respectively, after initiation of quinidine therapy; both survived. Syncope occurred within 8 days of initiation of quinidine therapy in three of the six patients. Sustained ventricular tachycardia was observed during quinidine associated arrhythmia in three of six patients with syncope; nonsustained ventricular tachycardia or complex ventricular ectopic activity while on this therapy was observed before syncope in the other three patients in Group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Child, Preschool; Digitoxin; Digoxin; Drug Administration Schedule; Electrocardiography; Heart Diseases; Hemodynamics; Humans; Quinidine; Syncope

Derivatives of dihydro-digitoxin (DHD) were studied in the search for a glycoside with a primarily extrarenal clearance and a faster elimination rate than digitoxin. The positive inotropic doses of the derivatives of DHD were higher than those of digitoxin and digoxin. There was no significant difference in the therapeutic margin. After injection of 3H-digoxin in unaesthetized cats, no metabolites were found in the serum which did not bind with the antibody used for the RIA. After injection of 3H-digitoxin and its derivatives, the radioactivity was cleared from the serum at a much lower rate than the concentrations assayed by RIA. The metabolites which did not bind to the digitoxin antibody were hydrophilic and had a low protein binding. Digitoxin-bisdigitoxoside (Dt-2) determined by RIA rapidly disappeared from the serum. The radioactivity remaining after 24 h was eliminated with a half-life of 219 h. Ten min after injection of DHD the serum contained no unchanged DHD, but 36% digitoxin suggesting that the reduction of digitoxin to DHD is reversible and that the conversion of DHD to Dt-2 is the rate limiting step in the metabolism of digitoxin. The total body clearance of digitoxin, its metabolites and derivatives determined by RIA increased in the order DHD-oxime less than or equal to digitoxin less than DHD less than or equal to DHD-acetyloxime less than DHD-methyloxime. The clearance and the elimination rate of DHD-methyloxime were significantly higher than those of digitoxin (P = 0.05).

Topics: Animals; Cats; Digitoxin; Digoxin; Electrocardiography; Female; Heart Diseases; Kinetics; Male; Myocardial Contraction; Protein Binding; Radioimmunoassay; Stimulation, Chemical

Topics: Arrhythmias, Cardiac; Coronary Disease; Digitalis; Drug Utilization; Heart; Heart Diseases; Humans; Kinetics; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Heart Diseases; History, Modern 1601-; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Plants, Medicinal; Plants, Toxic

Investigations by various teams have shown that combined treatment with verapamil and digoxin may result in a marked increase in digoxin plasma concentrations, necessitating a reduction in the dose of digoxin. This is mainly due to an impairment of the renal digoxin excretion. Unlike digoxin, the excretion of digitoxin is independent of renal function. A prospective clinical study was therefore planned to investigate the influence of a daily dose of 240 mg of verapamil on pharmacokinetics and the cardiac effect of digitoxin after a single dose (n = 3) and under steady-state conditions (n = 10). While pretreatment with verapamil did not alter pharmacokinetics of digitoxin in the single-dose study, there was a slight rise of digitoxin plasma concentrations (an average of 35% in 8 out of 10 patients) following administration of verapamil for a period of 4 to 6 weeks. Renal excretion of digitoxin, however, was not changed significantly. Simultaneous with a rise of digitoxin plasma concentrations and until a new steady state was reached, PQ interval was prolonged and T wave flattening intensified. On the other hand, the antagonistic effect on contractility which was initially observed after verapamil administration was diminished. Based on these observations, it can be concluded that the risk of digitalis overdose after combined treatment with verapamil and digitoxin may be less pronounced than after digoxin, and that this glycoside can prove a valuable alternative.

Topics: Aged; Arrhythmias, Cardiac; Digitoxin; Drug Therapy, Combination; Electrocardiography; Heart Diseases; Humans; Intestinal Absorption; Kinetics; Metabolic Clearance Rate; Middle Aged; Myocardial Contraction; Systole; Verapamil

Topics: Digitalis; England; Heart Diseases; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Plants, Medicinal; Plants, Toxic

Though he received his medical education in Edinburgh, William Withering was born and bred, and conducted his practice, in the Midlands of England, where he collaborated closely with medical and nonmedical colleagues who were pioneers of intellectual thought during the industrial revolution. Because of his profound botanical knowledge, he was able to identify Digitalis purpurea as the essential ingredient in a prescription dispensed by a herbalist, and systematically proceeded to show its value in patients with cardiac failure. He identified the cardinal symptoms of digitalis intoxication and worked out effective rules for the prescription of an infusion of digitalis. Withering's careful observations were also extended to botany and geology, and he was a key figure in the intellectual and scientific life of his area, a man whose legacy is not only the agent he identified but also the scrupulous way in which he evaluated it.

Topics: Digitalis; England; Heart Diseases; History, 18th Century; Humans; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; History, 18th Century; Humans; Plants, Medicinal; Plants, Toxic

Topics: Botany; Digitalis; England; Heart Diseases; History, 18th Century; Plants, Medicinal; Plants, Toxic

Topics: Aging; Animals; Blood Circulation; Body Temperature Regulation; Cardiac Output; Digitalis; Digoxin; Dopamine; Embryonic and Fetal Development; Fetal Heart; Heart Diseases; Humans; Infant, Newborn; Infant, Premature; Isoproterenol; Norepinephrine; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Sheep; Thyroid Hormones

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Drug Interactions; Heart Diseases; Heart Failure; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Heart Diseases; Humans; Plants, Medicinal; Plants, Toxic

As part of a blood-pressure survey in Munich, some of its inhabitants aged 30-69 years were asked by questionnaire about any digitalis medication. Chemically defined glycosides were taken by 127 of 1827 persons (7%), two-thirds of them older than 60 years, for clinically compensated chronic heart failure. Using the equation of Cockcroft and Gault to calculate creatinine clearance, it was below 80 ml/min and thus indicative of early impairment of renal function in more than 50%. In 44% the prescribed daily dose of glycoside corresponded to the calculated maintenance dose, 29% had less and 27% had taken more. None had clinical signs of digitalis intoxication. ECG changes possibly due to digitalis were much less common than had been expected. Sinus rhythm was present in 93%. More than 50% did not know why they were taking digitalis and 80% were taking two or more drugs at the same time. Since more than half had signs of early renal function impairment, creatinine clearance should be taken into account when determining the dosage of a digoxin preparation especially in elderly patients; alternatively, digitoxin should be prescribed. The survey also showed that a large number of persons on glycoside medication did not take the drug regularly.

Topics: Acetyldigoxins; Adult; Age Factors; Aged; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Germany, West; Heart; Heart Diseases; Humans; Hypertension; Kidney; Male; Middle Aged; Prospective Studies; Sex Factors

Topics: Computers; Digitalis; Drug Prescriptions; England; Heart Diseases; History, 18th Century; Humans; Pharmacology; Plants, Medicinal; Plants, Toxic

Since the introduction of digitalis into therapy approximately 200 years ago, there have been continuing admonitions concerning its toxicity. Over 400 years ago, herbalists listed the plant as being poisonous. In fiction, the homicidal use of digitalis has appeared in the writings of Mary Webb, Dorothy Sayers and Agatha Christie. Ten instances in real life of alleged homicide by digitalis and trials of the accused are listed. The drug has been used with suicidal intent rather infrequently, compared with other medications. Possibly, it is more commonly used for such a purpose in France than in England or the United States. The fraudulent use of digitalis in the support of claims for disability because of heart disease has occurred, and one large conspiracy of physicians and lawyers in the swindle of insurance companies during the 1930s is a shameful episode in the record of these professions. Although innocent, one professor of medicine who was involved committed suicide. Two pharmaceutical (manufacturing) blunders that occurred in Belgium and Holland with mislabeling are mentioned. These resulted in numerous deaths and the profession seemed rather slow to recognize the nature of these small epidemics of poisoning. Instances of psychiatric illness with digitalis seem well documented. The story of digitalis toxicity continues into the present and physicians should be vigilant regarding the drug's potential for poisoning that can result from prescribing digitalis with ignorance of proper dosage, pharmacodynamics or drug interactions, as well as from accidental overdose as in children and use with self-destructive or homicidal intent.

Topics: Cardiology; Digitalis; Factitious Disorders; Forensic Medicine; Heart Diseases; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Literature, Modern; Medication Errors; Plants, Medicinal; Plants, Toxic; Suicide

Topics: Adult; Child; Digitalis; Heart Diseases; Heart Failure; Humans; Kidney Failure, Chronic; Kinetics; Long-Term Care; Plants, Medicinal; Plants, Toxic

The problems of digitalis therapy are closely related to the intoxication rate of 10-20% in patients under longterm treatment. Awareness of the problems occurring in digitalis therapy should result in a decrease in the intoxication rate. This can be accomplished by (1) information to the patient and (2) information to the physician regarding the pitfalls of digitalis therapy. In this context reference will be made to therapeutic range, mode of digitalization, absorption, conditions associated with decreased digitalis tolerance, conditions involving increased need of digitalis, conditions associated with decreased need for digitalis, and drug interactions.

Topics: Digitalis; Drug Interactions; Heart Diseases; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Topics: Anesthesia; Anesthetics; Digitalis; Drug Interactions; Heart Diseases; Humans; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Preoperative Care; Propranolol; Risk; Surgical Procedures, Operative

This fluoroimmunoassay for digitoxin in serum involves use of a sheep antiserum to digitoxin coupled to magnetizable solid-phase particles and fluorescein-labeled 3-O-succinyl digitoxigenin as tracer. Sodium salicylate blocks binding of the drug by binding proteins, and endogenous fluorophores and other interfering components in serum samples are reliably and completely removed at the separation and wash steps, which are facilitated by magnetic sedimentation. The method is sufficiently sensitive, precise, and specific for application to routine monitoring of digitoxin therapy, and results correlate closely (r = 0.992) with those of an established radioimmunoassay.

Topics: Digitoxin; Fluoresceins; Heart Diseases; Humans; Immunoassay; Radioimmunoassay; Reference Values

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Hemodynamics; Humans; Plants, Medicinal; Plants, Toxic; Preoperative Care

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

Topics: Acute Disease; Adrenal Cortex Hormones; Altitude; Capillary Permeability; Digitalis; Heart Diseases; Humans; Plants, Medicinal; Plants, Toxic; Pulmonary Edema

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plants, Medicinal; Plants, Toxic

Topics: Adult; Aged; Angina Pectoris; Digitoxin; Echocardiography; Electrocardiography; Female; Heart; Heart Auscultation; Heart Diseases; Heart Failure; Hemodynamics; Humans; Hypertension; Kidney Diseases; Male; Middle Aged; Renal Dialysis; Risk

Topics: Digitalis; Heart Diseases; Heart Failure; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic; Time Factors

Topics: Adult; Aged; Digitoxin; Heart Diseases; Humans; Middle Aged; Radioimmunoassay

Serum concentrations of digitoxin and digoxin were measured in 145 cases with various heart diseases receiving maintenance doses of digitalis. Digitalis toxicity was seen in only 2 cases (1.4%). Day-to-day variation of serum concentration while taking the same daily dose was small in digitoxin therapy (13.8%), but a considerable variation was seen in digoxin therapy (24.4%). Serum concentrations of both digitoxin and digoxin were measured in the patients receiving digitoxin, and there was a positive correlation between the two (r = 0.66, p less than 0.001). This fact suggested that the effect of digitoxin was the sum of the effects of digitoxin and its metabolite, digoxin. In the patients taking digoxin, digitoxin was not detected in the serum. Serum digitoxin level had a significantly positive correlation to serum albumin level, presumably because digitoxin was retained in serum in the bound form to albumin. Minimal effective level, 10 ng/ml, was however obtained with higher daily dose of digitoxin in patients with lower serum albumin.

Topics: Adolescent; Adult; Aged; Digitoxin; Digoxin; Female; Heart Diseases; Humans; Male; Middle Aged; Radioimmunoassay

Topics: Adult; Digitalis Glycosides; Digitoxin; Digoxin; Drug Therapy, Combination; Female; Heart Diseases; Heart Failure; Humans; Infusions, Parenteral; Lanatosides; Male; Organomercury Compounds; Time Factors

Topics: Digitalis Glycosides; Digitoxin; Heart Diseases; Humans; Kidney; Kidney Failure, Chronic; Lanatosides; Liver

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Lanatosides

Topics: Alcoholism; Cardiomegaly; Cell Membrane Permeability; Diagnosis, Differential; Diet Therapy; Digitalis; Diuretics; Electrocardiography; Electrolytes; Ethanol; Heart Conduction System; Heart Diseases; Heart Failure; Humans; Mitochondria; Myofibrils; Nutrition Disorders; Plants, Medicinal; Plants, Toxic; Substance Withdrawal Syndrome; Thiamine; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Electric Countershock; Female; Heart; Heart Diseases; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic

Topics: Administration, Oral; Aged; Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Digoxin; Heart Block; Heart Diseases; Heart Failure; Humans; Hyperthyroidism; Injections, Intravenous; Kidney Failure, Chronic; Middle Aged; Obesity; Ventricular Fibrillation

Topics: Digitoxin; Digoxin; Heart Diseases; Humans; Magnesium; Poisoning; Radioimmunoassay; Spectrum Analysis; Uremia

Topics: Cerebrovascular Disorders; Digitoxin; Heart Diseases; Humans; Ouabain; Strophanthins

Topics: Adult; Age Factors; Aged; Bufanolides; Digitalis Glycosides; Digitoxin; Digoxin; Drug Evaluation; Female; Heart Diseases; Humans; Lanatosides; Male; Middle Aged; Plants, Medicinal; Strophanthins; Time Factors

Topics: Adrenal Gland Diseases; Adult; Arrhythmias, Cardiac; Athletic Injuries; Autopsy; Cardiomegaly; Cholelithiasis; Coronary Vessel Anomalies; Coronary Vessels; Death, Sudden; Digitalis; Electrocardiography; Heart Conduction System; Heart Diseases; Humans; Male; Military Medicine; Myocarditis; Myocardium; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Quinidine; Thymus Gland

Topics: Biopharmaceutics; Digitalis; Heart Conduction System; Heart Diseases; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Administration, Oral; Animals; Digitoxin; Digoxin; Dog Diseases; Dogs; Female; Heart Diseases; Injections, Intravenous; Male; Protein Binding; Tritium

Topics: Adult; Aged; Biological Assay; Cardiac Glycosides; Digitoxin; Digoxin; Female; Heart Diseases; Humans; Male; Methods; Middle Aged; Radioisotopes; Rubidium

Topics: Adult; Aortic Valve Insufficiency; Atrial Fibrillation; Bicarbonates; Blood Proteins; Body Composition; Body Water; Body Weight; Bromine; Cardiac Complexes, Premature; Chlorides; Creatinine; Digitalis; Diuretics; Female; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Potassium Chloride; Potassium Isotopes; Sodium; Sodium Isotopes; Spironolactone; Tachycardia

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: Age Factors; Blood Pressure; Body Height; Body Weight; Cardiac Catheterization; Cardiac Output; Digitalis; Female; Heart; Heart Diseases; Humans; Male; Oxygen; Plants, Medicinal; Plants, Toxic; Sex Factors; Time Factors

Topics: Adolescent; Child; Child, Preschool; Digitalis; Edema; England; Female; Heart Diseases; History, 18th Century; Humans; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Reference Books

Topics: Acute Disease; Bundle-Branch Block; Computers; Coronary Vessels; Diagnosis, Computer-Assisted; Diagnosis, Differential; Diaphragm; Digitalis; Electrocardiography; Heart Block; Heart Diseases; Heart Rate; Heart Ventricles; Humans; Hypertrophy; Infarction; Ischemia; Mathematics; Mitral Valve; Myocardial Infarction; Pericarditis; Plants, Medicinal; Plants, Toxic; Potassium

Topics: Aged; Bundle-Branch Block; Cardiac Catheterization; Coronary Disease; Digitalis; Electrocardiography; Female; Heart Block; Heart Conduction System; Heart Diseases; Humans; Male; Middle Aged; Minor Surgical Procedures; Myocardial Infarction; Pacemaker, Artificial; Phytotherapy; Plants, Medicinal; Plants, Toxic; Postoperative Complications; Procainamide; Quinidine; Surgical Procedures, Operative; Time Factors

Topics: Coronary Disease; Digitalis; Diuretics; Heart Diseases; Heart Failure; Humans; Hypertension; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Aged; Aminophylline; Atrial Fibrillation; Autopsy; Digitalis; Diuretics; Electrocardiography; Female; Granuloma, Giant Cell; Heart Diseases; Humans; Myocarditis; Phytotherapy; Plants, Medicinal; Plants, Toxic

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: Aged; Agglutinins; Aortic Valve Stenosis; Blood Platelets; Cells, Cultured; Digitoxin; Digoxin; Female; Heart Diseases; Hemagglutination Tests; Humans; Lymphocyte Activation; Lymphocytes; Thrombocytopenia

Topics: Animals; Digitoxin; Female; Fludrocortisone; Heart Diseases; Microscopy, Electron; Myocardium; Nephrectomy; Oils; Phosphates; Rats

Topics: Administration, Oral; Digitalis; Digitoxin; Digoxin; Heart Diseases; Humans; Lanatosides; Plants, Medicinal; Plants, Toxic

Topics: Adolescent; Adult; Age Factors; Aged; Amphetamine; Cathartics; Child; Digitalis; Diuretics; Drug Synergism; Female; Heart Diseases; Humans; Hypertension; Male; Methods; Middle Aged; Obesity; Plants, Medicinal; Plants, Toxic; Sex Factors; Thyroid Hormones; Time Factors

Topics: Adult; Aged; Arrhythmias, Cardiac; Coronary Disease; Diagnosis, Differential; Digitalis; Electrocardiography; Female; Heart; Heart Atria; Heart Diseases; Heart Failure; Humans; Hypertension; Male; Middle Aged; Muscle Contraction; Plants, Medicinal; Plants, Toxic

Topics: Adenosine Triphosphatases; Animals; Anura; Biotransformation; Brain; Calcium; Cardanolides; Cats; Chemistry Techniques, Analytical; Depression, Chemical; Digitalis Glycosides; Digitoxin; Dogs; Drug Synergism; Heart; Heart Diseases; Heart Failure; Humans; Liver; Myocardium; Ouabain; Potassium; Rabbits; Rats; Stimulation, Chemical; Time Factors

Topics: Administration, Oral; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Intestinal Absorption

Topics: Cardiac Glycosides; Cardiac Output; Digitoxin; Digoxin; Heart Diseases; Heart Rate; Humans; Lanatosides; Methods; Time Factors

Topics: Adrenal Cortex Hormones; Amiloride; Animals; Catecholamines; Digitoxin; Diuretics; Epinephrine; Heart Diseases; Kidney; Magnesium; Metabolic Diseases; Necrosis; Oils; Phenoxybenzamine; Potassium; Potassium Chloride; Propranolol; Pyrazines; Rats; Sodium; Stress, Physiological

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Myocardial Infarction; Myocardium

Topics: Adult; Aged; Arrhythmias, Cardiac; Digitoxin; Follow-Up Studies; Heart Diseases; Heart Failure; Humans; Middle Aged

Topics: Administration, Oral; Adult; Aged; Digitalis; Digitalis Glycosides; Digitoxin; Drug Compounding; Female; Heart Diseases; Humans; Injections, Intravenous; Male; Middle Aged; Plants, Medicinal; Plants, Toxic

Topics: Arrhythmias, Cardiac; Biliary Tract; Digitalis Glycosides; Digitoxin; Digoxin; Gastrointestinal Diseases; Heart Diseases; Humans; Intestinal Absorption; Kidney; Lanatosides; Liver; Lung; Muscles; Myocardium; Nervous System Diseases; Strophanthins; Vision Disorders

Topics: Animals; Aortic Diseases; Blood Pressure; Body Weight; Digitoxin; Disease Models, Animal; Female; Heart; Heart Diseases; Hypertrophy; Organ Size; Physical Exertion; Rats; Swimming

Topics: Acute Disease; Adolescent; Adult; Aged; Child; Digitoxin; Electrocardiography; Heart; Heart Diseases; Humans; Middle Aged

Topics: Aged; Bradycardia; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Heart Auscultation; Heart Diseases; Hemodynamics; Humans; Male; Middle Aged; Muscle Contraction; Plants, Medicinal

Topics: Adsorption; Aged; Antibodies; Binding Sites; Blood Urea Nitrogen; Body Weight; Charcoal; Dextrans; Digitoxin; Electrocardiography; Female; Heart Diseases; Humans; Male; Methods; Middle Aged; Potassium; Protein Binding; Radioimmunoassay; Sex Factors; Tritium

Topics: Adult; Digitoxin; Digoxin; Female; Heart; Heart Diseases; Heart Function Tests; Heart Rate; Humans; Injections, Intravenous; Male; Methods; Middle Aged; Radioisotopes; Rubidium

Topics: Aged; Aging; Blood Pressure; Digitoxin; Female; Heart Diseases; Heart Rate; Humans; Hypertension; Male; Pulse

Topics: Administration, Oral; Cardiac Glycosides; Digitoxin; Digoxin; Drug Combinations; Heart Diseases; Humans; Injections, Intravenous; Strophanthins

Topics: Arrhythmias, Cardiac; Cardiac Glycosides; Digitalis; Edetic Acid; Electric Countershock; Electrocardiography; Heart Diseases; Humans; Phenytoin; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Strophanthins; Ventricular Fibrillation

Topics: Animals; Aspartic Acid; Cricetinae; Diet; Digitoxin; Disease Models, Animal; Edema; Epinephrine; Female; Heart Diseases; Heart Failure; Magnesium; Male; Muscular Dystrophies; Myocardium; Orotic Acid; Potassium; Potassium Chloride; Propranolol

Topics: Cardiac Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Lanatosides; Strophanthins

Topics: Animals; Cats; Digitoxin; Female; Heart Diseases; Lanatosides; Male; Strophanthins

Topics: Adult; Aspartic Acid; Digitoxin; Electrocardiography; Female; Heart Block; Heart Diseases; Humans; Magnesium; Male; Middle Aged; Sodium; Tachycardia

Topics: Aged; Chlormethiazole; Dementia; Digitoxin; Heart Diseases; Histamine H1 Antagonists; Humans; Intracranial Arteriosclerosis; Piperazines

Topics: Angina Pectoris; Coronary Disease; Digitalis; Heart Conduction System; Heart Diseases; Humans; Nausea; Plants, Medicinal; Plants, Toxic; Strophanthins; Vomiting

Topics: Arrhythmias, Cardiac; Atropine; Child; Deafness; Digitalis; Electrocardiography; Female; Heart Diseases; Humans; Plants, Medicinal; Plants, Toxic; Potassium Chloride; Ventricular Fibrillation

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Cardiac Glycosides; Digitalis Glycosides; Digitoxin; Heart Diseases; Heart Failure; Humans; Pulse; Strophanthins; Tachycardia, Paroxysmal

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: Color Perception; Digitoxin; Drug Therapy; Eye Manifestations; Heart Diseases; Poisoning; Sensitivity and Specificity; Toxicology

Topics: Animals; Digitoxin; Dipyridamole; Heart Diseases; Hypoxia; Mitochondria; Mitochondria, Muscle; Oxygen; Pentaerythritol Tetranitrate; Rats

Topics: Digitalis; Digoxin; Drug Therapy; Geriatrics; Heart Diseases; Iatrogenic Disease; Toxicology

Topics: Diagnosis; Digitalis; Digitalis Glycosides; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Heart Diseases; Poisoning; Toxicology

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Humans; Plant Extracts; Triclosan

Topics: Cardiac Surgical Procedures; Cardiac Tamponade; Dexamethasone; Digitoxin; Electrocardiography; Heart; Heart Diseases; Hemophilia A; Humans; Pericardial Effusion; Pericardiectomy; Pericardium; Postoperative Complications; Radiography, Thoracic; Thoracic Surgery

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Humans; Lanatosides; Plant Extracts

Topics: Cardiac Glycosides; Digitalis Glycosides; Digitoxin; Digoxin; Drug Therapy; Glycosides; Heart Diseases; Lanatosides; Strophanthins; Toxicology

Topics: Cardiotonic Agents; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Drug Therapy; Heart Diseases; Humans; Lanatosides

Topics: Cardiomegaly; Coronary Disease; Digitalis; Digitalis Glycosides; Diuretics; Drug Therapy; Heart Diseases; Heart Failure; Humans; Hypertension

Topics: Adrenal Medulla; Catecholamines; Digitalis; Digitalis Glycosides; Epinephrine; Heart; Heart Diseases; Heart Failure; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Natriuresis; Norepinephrine; Pericarditis; Strophanthins; Urination; Urine

Topics: Anesthesia; Barbiturates; Brain; Brain Damage, Chronic; Cardiac Surgical Procedures; Dehydration; Delirium; Depression; Digitalis; Hallucinations; Heart Diseases; Humans; Hypnosis; Hyponatremia; Hysteria; Postoperative Complications; Sleep Wake Disorders; Substance Withdrawal Syndrome; Thoracic Surgery; Toxicology

Topics: Anti-Infective Agents, Local; Biomedical Research; Digitalis; Digitalis Glycosides; Heart Diseases; Humans

Topics: Aging; Cardiovascular Agents; Digitalis; Digitalis Glycosides; Diuretics; Drug Tolerance; Geriatrics; Heart Diseases; Iatrogenic Disease; Norway; Statistics as Topic; Toxicology

Topics: Adolescent; Biomedical Research; Chemistry, Pharmaceutical; Digitalis; Digitalis Glycosides; Digoxin; Geriatrics; Heart Diseases; Pharmacology; Pharmacy; Toxicology

Topics: Cardiac Glycosides; Child; Choice Behavior; Digitalis; Digitalis Glycosides; Dosage Forms; Heart Diseases; Heart Failure; Humans; Infant; Pharmacology; Plant Extracts; Toxicology

Topics: Biomedical Research; Digitalis; Digitalis Glycosides; Digoxin; Geriatrics; Glucosides; Heart Diseases; Humans

Topics: Aged; Anticoagulants; Digitalis; Digitalis Glycosides; Drug Therapy; Geriatrics; Heart Diseases; Humans; Hypertension; Myocardial Infarction; Norepinephrine

Topics: Coronary Disease; Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Heart Valve Diseases; Hypertension; Hypertension, Pulmonary; Hyperthyroidism; Pharmacology; Toxicology; Ventricular Fibrillation

Topics: Cardiology; Digitalis; Digitalis Glycosides; Drug Therapy; Heart Diseases; Plant Extracts; Poisoning; Toxicology

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart Diseases; Poisoning; Prognosis; Toxicology

Topics: Acetyldigitoxins; Digitoxin; Female; Heart Diseases; Humans; Pregnancy; Pregnancy Complications

Topics: Digitalis; Digitalis Glycosides; Electrocardiography; Heart Diseases; Humans; Potassium; Tachycardia

Topics: Digitalis; Digoxin; Exercise; Heart Diseases; Heart Failure; Humans; Metabolism; Oxygen; Oxygen Consumption; Physical Exertion

Topics: Blood Circulation; Coronary Vessels; Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Hemodynamics; Humans

Topics: Digitalis; Digitalis Glycosides; Electrocardiography; Heart; Heart Diseases; Humans; Hypertension

Topics: Deslanoside; Digitalis; Heart Diseases; Humans; Lanatosides; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts

Topics: Cardiology; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts; Pyridoxine; Vitamin B 6; Vitamins

Topics: Digitalis; Digitalis Glycosides; Empiricism; Heart Diseases; Humans; Pharmacology; Science

Topics: Digitalis; Digitalis Glycosides; Diuretics; Electrocardiography; Heart Diseases; Heart Failure; Heart Septum; Humans; Morphine; Myocardial Infarction; Norepinephrine; Vasodilator Agents

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Digitoxin; Heart Diseases

Topics: Aged; Aged, 80 and over; Aging; Chlorothiazide; Digitalis; Digitalis Glycosides; Heart Diseases; Tranquilizing Agents

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Heart Failure; Quinidine

Topics: Digitalis; Digitalis Glycosides; Glycosides; Heart Diseases; Humans

Topics: Aged; Aged, 80 and over; Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Humans

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart; Heart Diseases

Topics: Acetyldigitoxins; Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Glycosides; Heart Diseases

Topics: Amyloidosis; Digitalis; Disease; Heart Diseases; Humans; Medical Records; Myocardium

Topics: Cardiotonic Agents; Digitalis; Diuretics; Enzyme Inhibitors; Heart Diseases; Reserpine; Strophanthins

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart; Heart Diseases

Topics: Cardiac Volume; Densitometry; Digitalis; Digitalis Glycosides; Heart; Heart Diseases

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Electrocardiography; Heart Diseases; Myocardium

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Plant Extracts; Thiamine Pyrophosphate

Topics: Acetyldigitoxins; Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases

Topics: Cardiac Surgical Procedures; Digitalis; Heart Diseases; Plant Extracts; Thoracic Surgery

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases

Topics: Anti-Arrhythmia Agents; Digitalis; Digoxin; Enzyme Inhibitors; Heart Diseases

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Cardiovascular Agents; Digitalis; Heart Diseases; Humans

Topics: Digitalis; Digitalis Glycosides; Diuretics; Dyspnea; Heart Diseases; Heart Failure; Humans

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Hospitals, General; Humans; Metabolic Diseases; Potassium

Topics: Acetyldigitoxins; Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Plant Extracts

Topics: Child; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Infant; Pediatrics; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digoxin; Enzyme Inhibitors; Heart Diseases; Humans

Topics: Digitalis; Heart; Heart Diseases; Hemodynamics; Humans; Lanatosides

Topics: Aged; Ascorbic Acid; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Vitamins

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digoxin; Enzyme Inhibitors; Heart Diseases; Humans

Topics: Barbiturates; Digitalis; Heart Diseases; Humans; Nausea; Prochlorperazine; Vomiting

Topics: Anti-Arrhythmia Agents; Digitalis; Enzyme Inhibitors; Heart Diseases; Humans; Plant Extracts

Topics: Acetyldigitoxins; Digitalis; Enzyme Inhibitors; Heart Diseases; Plant Extracts

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Lactates; Sodium Lactate

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Enzyme Inhibitors; Heart Diseases; Humans; Plant Extracts

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Iatrogenic Disease; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Diuretics; Heart Diseases

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Strophanthins; Strophanthus

Topics: Anti-Arrhythmia Agents; Digitalis; Disease; Heart; Heart Diseases; Humans; Lanatosides; Pancreas; Pancreatic Diseases

Topics: Anti-Arrhythmia Agents; Crataegus; Digitalis; Diuretics; Heart Diseases; Humans; Plant Extracts

Topics: Body Fluids; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Potassium

Topics: Child; Digitalis; Digoxin; Heart Diseases; Humans; Infant

Topics: Acetyldigitoxins; Child; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Infant; Plant Extracts

Topics: Anti-Arrhythmia Agents; Blood Coagulation; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Glycosides; Heart Diseases; Heparin; Humans; Strophanthins

Topics: Acetyldigitoxins; Blood Coagulation; Digitalis; Digitalis Glycosides; Disease; Heart Diseases; Heart Valve Diseases; Hemodynamics; Humans; Mitral Valve; Rheumatic Heart Disease

Topics: Acetyldigitoxins; Atrial Fibrillation; Cardiac Glycosides; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Disease; Heart Diseases; Heart Failure; Humans; Mitral Valve; Tachycardia; Tachycardia, Paroxysmal

Topics: Digitalis; Digitalis Glycosides; Exercise; Heart; Heart Diseases; Humans; Oxygen Consumption

Topics: Administration, Intravenous; Chronic Disease; Digitalis; Disease; Heart Diseases; Hemodynamics; Humans; Lanatosides; Mitral Valve

Topics: Crataegus; Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Niacin; Nicotinic Acids; Procainamide; Quinidine

Topics: Digitalis; Diuretics; Enzyme Inhibitors; Heart Diseases; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Diuretics; Heart Diseases

Topics: Digitalis; Disease; Heart Diseases; Heart Valve Diseases; Humans; Injections, Intravenous; Kidney; Lanatosides; Mitral Valve; Renal Circulation

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Plants

Topics: Digitalis; Heart Diseases; Lanatosides; Myocardium; Strophanthins; Typhoid Fever

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Diuretics; Heart Diseases

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Strophanthins

Topics: Atrial Fibrillation; Bundle-Branch Block; Digitalis; Digitalis Glycosides; Heart Block; Heart Diseases; Humans; Quinidine; Tachycardia

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Diseases

Topics: Biological Therapy; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases

Topics: Acetyldigitoxins; Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Diuretics; Heart Diseases

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Digitoxin; Heart Diseases

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Digitoxin; Diuretics; Heart Diseases

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

Topics: Anti-Arrhythmia Agents; Digitalis; Diuretics; Heart Diseases; Humans; Strophanthins

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Strophanthins

Topics: Digitalis; Female; Heart Diseases; Humans; Lanatosides; Plant Extracts; Pregnancy

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Enzyme Inhibitors; Heart Diseases; Ouabain; Strophanthins

Topics: Child; Digitalis; Digitalis Glycosides; Glucosides; Heart Diseases; Humans; Infant; Pediatrics; Therapeutic Uses

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Glycosides; Heart Diseases; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Gynecomastia; Heart Diseases; Humans; Male; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Acetyldigitoxins; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Child; Digitalis; Digitalis Glycosides; Digitoxin; Heart; Heart Diseases; Infant

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Heart Diseases; Heart Failure; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Lanatosides

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Strophanthins

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Tachycardia

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plants, Medicinal

Topics: Animals; Biological Transport; Cats; Diet; Digitalis; Digitoxin; Heart Diseases; Rats; Streptomycin; Tissue Distribution

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Emetics; Heart; Heart Diseases

Topics: Anti-Arrhythmia Agents; Digitalis; Diuretics; Heart Diseases; Humans

Topics: Cardiology; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Digitalis; Diuretics; Heart Diseases; Humans

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Humans; Kidney Function Tests

Topics: Anti-Arrhythmia Agents; Digitalis; Diuretics; Heart Diseases; Humans; Plants, Medicinal; Scilla

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Quinidine

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Lanatosides; Plant Extracts

Topics: Digitalis; Drug-Related Side Effects and Adverse Reactions; Heart Diseases

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts; Strophanthins; Vitamin E

Topics: Aged; Digitalis; Digitalis Glycosides; Disease; Heart Diseases; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Strophanthins

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Myocarditis; Rheumatic Diseases; Rheumatic Heart Disease; Strophanthus

Topics: Cardiovascular System; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Mitral Valve; Plant Extracts; Risk

Topics: Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts; Strophanthins

Topics: Bufanolides; Digitalis; Drimia; Glycosides; Heart Diseases; Humans

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Heart Failure; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Heart Failure; Humans

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Diseases

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Diphtheria; Heart Diseases; Humans

Topics: Digitalis; Digitalis Glycosides; Heart Diseases; Plant Extracts