digitoxin and Heart-Failure

Publishe d decades after several randomized controlled trials (RCT) demonstrating decreased hospitalizations and no effect on all-cause mortality with digoxin use, a series of meta-analyses linking digoxin treatment and mortality have contributed to a narrower application of this medication for the management of heart failure (HF) and atrial fibrillation (AF). Given the conflicting data from the earlier RCTs and more recent meta-analyses, there is a growing polarization among providers for and against the use of digoxin in managing these conditions.. To help close this divide, we provide a perspective on the literature with special attention to the quality of both older and more recent studies on this subject.. The data from the highest quality studies we have, RCTs, suggest that digoxin use in patients with HF and/or AF is associated with improvement in several areas of outcomes including functional capacity, symptom management, reduced hospitalizations, fewer deaths due to HF, and treatment of refractory chronic heart failure with rEF, and may even have overall mortality benefit when serum digoxin concentrations are within therapeutic range. These effects are more pronounced in patients with EF < 25% and NYHA Class II-IV and at highest risk for hospitalization.. As the risk of confounding factors was minimized by the study design, the likelihood that positive outcomes were identified with digoxin use increased. Clinicians and researchers need further adequately designed and powered RCTs exploring the connection between digoxin therapy and mortality, hospitalizations, and symptom management.

Topics: Atrial Fibrillation; Digitalis; Digoxin; Heart Failure; Humans; Randomized Controlled Trials as Topic

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Topics: Cardiac Glycosides; Digitalis; Heart Failure; Hypertension; Ligands

Drug repositioning is a successful approach in medicinal research. It significantly simplifies the long-term process of clinical drug evaluation, since the drug being tested has already been approved for another condition. One example of drug repositioning involves cardiac glycosides (CGs), which have, for a long time, been used in heart medicine. Moreover, it has been known for decades that CGs also have great potential in cancer treatment and, thus, many clinical trials now evaluate their anticancer potential. Interestingly, heart failure and cancer are not the only conditions for which CGs could be effectively used. In recent years, the antiviral potential of CGs has been extensively studied, and with the ongoing SARS-CoV-2 pandemic, this interest in CGs has increased even more. Therefore, here, we present CGs as potent and promising antiviral compounds, which can interfere with almost any steps of the viral life cycle, except for the viral attachment to a host cell. In this review article, we summarize the reported data on this hot topic and discuss the mechanisms of antiviral action of CGs, with reference to the particular viral life cycle phase they interfere with.

Topics: Antiviral Agents; Cardiac Glycosides; COVID-19; Digitoxin; Digoxin; Drug Repositioning; Heart Failure; Humans; Neoplasms; Ouabain; Pandemics; SARS-CoV-2; Sodium-Potassium-Exchanging ATPase; Virus Internalization; Virus Replication

Heart failure (HF) is a medical condition inability of the heart to pump sufficient blood to meet the metabolic demand of the body to take place. The number of hospitalized patients with cardiovascular diseases is estimated to be more than 1 million each year, of which 80% to 90% of patients ultimately progress to decompensated HF. Digitalis glycosides exert modest inotropic actions when administered to patients with decompensated HF. Although its efficacy in patients with HF and atrial fibrillation is clear, its value in patients with HF and sinus rhythm has often been questioned. A series of recent studies have cast serious doubt on the benefit of digoxin when added to contemporary HF treatment. We are hypothesizing the role and mechanism of exosome and its biological constituents responsible for worsening the disease state and mortality in decompensated HF patients on digitalis.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiotonic Agents; Digitalis; Digoxin; Exosomes; Heart Failure; Humans; Plant Extracts; Wnt Signaling Pathway

Digoxin is the oldest known treatment for heart failure (HF) and has been demonstrated to reduce admissions for worsening heart failure in a large randomized trial recruiting patients in sinus rhythm with heart failure and ejection fraction <45%. This study forms the basis for current international guidelines recommending that digoxin should be considered in patients with symptomatic HF despite optimal doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists in addition to device therapy, if indicated. However, digoxin predates mortality reducing HF therapies, and this article reviews the historical and recent data.. Multiple PubMed searches were performed including, but not limited to, the search terms "digoxin," "heart failure," "efficacy," "treatment," "side-effects," "morbidity," "mortality," and "arrythmia." Articles were excluded if not relevant, not in English or without abstract. Reference lists of relevant articles were manually searched for further references. Due to the large number of articles retrieved, a selection was reviewed based on the authors' best judgement.. Three randomized controlled trials and three large contemporary observational reports of digoxin therapy in heart failure and sinus rhythm were retrieved. Other studies were noted that included patients with heart failure and atrial fibrillation, which were also reviewed.. Definitive randomized evidence of digoxin efficacy as add-on therapy in HF is lacking because most landmark trials of modern HF disease modifying agents postdate the randomized studies of digoxin. Furthermore, questions remain regarding the optimum dose of digoxin and there are signals that digoxin may be harmful in some patients with HF. All contemporary data for digoxin in HF are derived from observational studies and the findings are conflicting. Despite two centuries of experience using cardiac glycosides to treat HF, fundamental questions regarding the efficacy and safety of digoxin in HF remain unanswered.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiotonic Agents; Digitalis; Digoxin; Heart Failure; Humans; Risk Assessment; Risk Factors; Treatment Outcome

Digoxin is one of the oldest of drugs acting on the heart and still one of the most frequently used. While in atrial fibrillation digoxin continues to have a valid role in the control of ventricular rate when added to beta-blockers and calcium antagonists, digoxin for heart failure is no longer a supportable option in view of the negative recent meta-analysis.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digitalis; Digoxin; Heart Failure; Humans; Plant Preparations

Cardiac insufficiency is a disease of old age. Analyses of subgroups have showed that old patients benefit to a particular extent from therapeutic measures the effectiveness of which has been confirmed in numerous studies. In the light of this knowledge, it is all the more difficult to understand why this group of patients are still not receiving effective treatment. In this area, there is an urgent need for improvement. Also difficult to understand is the fact that the guidelines for the treatment of chronic cardiac failure issued by the German Cardiology Society pay so little attention to cardiovascular research of cardiac insufficiency in old age, and thus bear indirect responsibility for the less than optimal treatment of this condition, which can be so severe in the old patient. These guidelines should contain a section on the peculiarities of cardiac insufficiency in high old age.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiotonic Agents; Clinical Trials as Topic; Diagnosis, Differential; Diastole; Digitoxin; Digoxin; Diuretics; Drug Therapy, Combination; Echocardiography, Doppler; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Pacemaker, Artificial; Practice Guidelines as Topic; Prevalence; Prognosis; Risk Factors

To quantify the prevalence of heart failure and left ventricular systolic dysfunction (LVSD) in chronic obstructive pulmonary disease (COPD) patients and vice versa. Further, to discuss diagnostic and therapeutic implications of the co-existence of both syndromes.. We performed a Medline search from 1966 to March 2005. The reported prevalence of LVSD among COPD patients varied considerably, with the highest prevalence (10-46%) among those with an exacerbation. One single study assessed the prevalence of heart failure in COPD patients. A prevalence of 21% of previously unknown heart failure was reported in patients with a history of COPD or asthma. We did not find any report on COPD in heart failure or LVSD patients. Diagnosing heart failure in COPD patients or vice versa is complicated by overlap in signs and symptoms, and diminished diagnostic value of additional investigations. In general, pulmonary and heart failure 'drug cocktails' can be administered safely to patients with concomitant COPD and heart failure, although (short acting) beta2-adrenoreceptor agonists and digitalis have potentially deleterious effects on cardiac and pulmonary function, respectively.. Although knowledge about the prevalence of concomitant heart failure in COPD patients and vice versa is scarce, it seems that the combined presence is rather common. In view of diagnostic and therapeutic implications, more attention should be paid to the concomitant presence of both syndromes in clinical practice and research.

Topics: Adrenergic beta-Agonists; Aged; Comorbidity; Digitalis; Female; Heart Failure; Humans; Male; Middle Aged; Prevalence; Pulmonary Disease, Chronic Obstructive

Foxglove and its constituents therapeutic agent digitalis have been used for centuries for the treatment of heart failure. All digitalis-like cardiotonic steroids enhance heart contraction through a mechanism involving the inhibition of the Na(+),K(+)- ATPase. Recently, Rathore and colleagues reported that sex-based differences may exist in the efficacy of digoxin for the treatment of heart failure. The authors of the study found that female patients exhibited increased risk of death associated with digoxin therapy, whereas male patients appeared to have no increased risk of death related to digoxin therapy. Blaustein and colleagues delve into the report and discuss possible explanations for these findings, suggest alternative ones, and advocate for enrolling greater numbers of women in clinical studies.

Topics: Animals; Clinical Trials as Topic; Digitalis; Digitalis Glycosides; Digoxin; Female; Heart Failure; Hormone Replacement Therapy; Humans; Male; Ouabain; Sex Factors; Sodium-Potassium-Exchanging ATPase

Topics: Administration, Oral; Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiotonic Agents; Chronic Disease; Clinical Trials as Topic; Digitalis; Diuretics; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Vasodilator Agents

Digitalis glycosides exert a positive inotropic effect, i.e. an increase in myocardial contractility associated with a prolongation of relaxation period, and glycosides lower the heart rate (negative chronotropic), impede stimulus conduction (negative dromotropic) and promote myocardial excitability (positive bathmotropic). They seem to influence the activities of both the vagal and the sympathetic systems. Digitalis glycosides that belong to different substance classes are closely comparable concerning pharmacodynamics but differ substantially in regard to pharmacokinetics. Digoxin and its derivatives are less lipophilic, show lower protein binding and shorter half-life, are mainly eliminated via the kidney and accumulate rather rapidly in cases of insufficient kidney function. Digitoxin is highly lipophilic and extensively bound to plasma proteins, has a longer half-life, is mainly eliminated in the metabolized state via urine and faeces and does not accumulate in kidney dysfunction. As a result of a more stable pharmacokinetic profile, the incidence of toxic side effects seems to be lower with digitoxin than with digoxin. Since the beginning of the 1990s, the antagonists of the RAAS qualified as the standard treatment for congestive heart failure, often in combination with diuretics, vasodilators or beta-antagonists. However, the important role of digitalis glycosides as therapeutic comedication or alternative was never denied, especially in atrial fibrillation with tachycardia. The PROVED and RADIANCE trials proved a detrimental effect of the withdrawal of digoxin therapy on exercise capacity, left-ventricular ejection fraction and clinical symptoms. The DIG trial revealed that digoxin comedication in sinus rhythm patients with congestive heart failure was associated with a lower morbidity (as taken from death or hospitalization because of worsening heart failure) and an unchanged overall mortality--being a unique feature among the available inotropic drugs. Comparable studies for digitoxin have not yet been performed but, because of its higher pharmacological stability, it might well be associated with even more advantages in this regard than digoxin.

Topics: Cardiotonic Agents; Digitoxin; Heart Failure; Humans

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

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Digitalis; Diuretics; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Adrenergic beta-Antagonists; Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiotonic Agents; Clinical Trials as Topic; Deoxyepinephrine; Digitalis; Evaluation Studies as Topic; Exercise Test; Follow-Up Studies; Heart Failure; Humans; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Time Factors; Vasodilator Agents; Xamoterol

Over the past 200 years, digoxin has been commonly used to treat patients with congestive heart failure. Clinical trials have demonstrated the benefits of the use of digoxin on exercise tolerance, ejection fraction, and neurohormone production. The Digoxin Investigators Group trial has recently provided strong evidence for the long-term benefits of digoxin on morbidity for patients with heart failure. This article will review the evidence of the benefits of digoxin and its current role in the treatment of patients with congestive heart failure.

Topics: Cardiotonic Agents; Digitalis; Digoxin; Exercise Tolerance; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic; Randomized Controlled Trials as Topic; Stroke Volume; Treatment Outcome

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Digitalis; Digoxin; Diuretics; Drug Therapy, Combination; Heart Failure; Hemodynamics; Humans; Plants, Medicinal; Plants, Toxic; Randomized Controlled Trials as Topic; Time Factors

The main purpose of using diuretics is usually lost sight of, i.e. it is for the relief of dyspnea by using the least amount of a diuretic. The production of a low output state and hypercoagulation in an attempt to achieve dry weight by lowering blood volume excessively are among the hazards of using more diuretic than is absolutely necessary to achieve the goal of relieving dyspnea. The use of jugular venous pressure measurement and the status of dyspnea should have precedence over body weight in determining diuretic dose adjustment. Often forgotten in using diuretics is that potassium without magnesium will not enter cells and that the almost universal preference for furosemide over thiazides threatens to increase the incidence of osteoporosis. Also, the tendency to ignore loss of the water-soluble vitamins thiamine and ascorbic acid may result in refractory edema and the inability to manage the stresses of congestive heart failure.

Topics: Animals; Calcium; Cardiac Output; Chronic Disease; Contraindications; Digitalis; Diuretics; Drug Interactions; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Risk Factors; Uric Acid

Over the past 20 to 30 years there have been significant advances in the management of heart failure related to improved understanding of pathophysiology, better methods of assessment, and improved drug treatments. The aims of treatment have broadened, with increased emphasis on earlier intervention. Clinical research activity in this area has been considerable, increasingly allowing an evidence-based approach to management. Most earlier trials of treatment were relatively short-term, small-group studies with various clinical end points, including severity of symptoms, exercise performance, and left ventricular function assessment; however, increasingly a higher standard of evidence has been required, including a provision of reliable, large-scale mortality trial data. This has been further encouraged, if not mandated, by the relatively recent appreciation that some agents may demonstrate dissociation of treatment effects, possibly dose related, with improved short-term outcomes but adverse effects on survival with prolonged treatment. The general principles of management of congestive heart failure encompass patient evaluation and confirmation of the diagnosis, consideration, and correction of underlying remediable causes and precipitating factors, pharmacological treatment, patient education and counseling, and planned follow-up, as summarized in recently published guidelines. This review focuses primarily on the available randomized controlled clinical trial evidence related to the pharmacological treatment of the clinical congestive heart failure syndrome. Other aspects of management, such as patient education, counseling, and planned follow-up, should be regarded as complementary to pharmacological treatment and important to ensure compliance and optimal long-term outcomes.

Topics: Adrenergic beta-Antagonists; Amiodarone; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Digitalis; Diuretics; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Survival Analysis; Ventricular Dysfunction

Depression of myocardial contractility plays an important role in the development of heart failure; therefore, intensive interest and passion have been generated to develop cardiotonic agents to improve the contractile function of the failing heart. Inotropic agents that increase cyclic AMP, either by increasing its synthesis or reducing its degradation, exert dramatic short-term hemodynamic benefits, but these acute effects cannot be extrapolated into long-term improvement of the clinical outcome in patients with advanced heart failure. Administration of these agents to an energy-starved failing heart would be expected to increase myocardial energy use and could accelerate disease progression. The role of digitalis in the management of heart failure has been controversial, but ironically the drug has now been proved to favorably affect the neurohormonal disorders and its reevaluation is now being intensively investigated. More recently, attention has been focused on other inotropic agents that have a complex and diversified mechanism. Recent clinical studies have demonstrated that they are potentially useful in the long-term treatment of heart failure patients. These agents have some phosphodiesterase-inhibitory action but also possess additional effects, including acting as cytokine inhibitors, immunomodulators, or calcium sensitizers. However, their therapeutic ratio is narrow and further studies are warranted to establish their optimal doses and their eventual status in the treatment of heart failure.

Topics: Adrenergic beta-Agonists; Cardiotonic Agents; Cyclic AMP; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Prognosis; Pyrazines; Pyridazines; Quinolines

Topics: Adrenergic Agents; Cardiotonic Agents; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

To determine patterns of medication use based on clinical variables in patients with heart failure, we analyzed data from 5,999 patients participating in the Registry of Studies of Left Ventricular Dysfunction (SOLVD). The Registry comprised a broad spectrum of patients with heart failure, including some with predominantly diastolic dysfunction. Drug use was determined in a population cross-sectional manner at the time of identification (74% hospitalized). The median number of drugs per patient was four, with diuretics taken by 62%, digitalis by 45%, angiotensin-converting enzyme inhibitors (ACE-I) by 32%, calcium channel blockers by 36%, antiarrhythmics by 22%, and beta-blockers by 18%. Only 18% were on the combination of ACE-I, diuretic, and digitalis. Stratification for diagnosis, heart failure symptoms, and ejection fractions demonstrated that triple-drug therapy (digitalis, diuretic, and ACE-I) was common only in those with ejection fractions less than .20 and several signs or symptoms of heart failure. Older patients were taking diuretics frequently (73% of patients older than 70 years of age), and our European center used fewer drugs overall, while prescribing digitalis about half as frequently as North American clinics. These data serve as the baseline for analysis of evolving therapeutic practice in patients with heart failure.

Topics: Aged; Belgium; Calcium Channel Blockers; Canada; Cross-Sectional Studies; Digitalis; Diuretics; Double-Blind Method; Drug Therapy, Combination; Drug Utilization Review; Female; Heart Failure; Humans; Male; Middle Aged; Multicenter Studies as Topic; Peptidyl-Dipeptidase A; Plants, Medicinal; Plants, Toxic; Practice Patterns, Physicians'; Randomized Controlled Trials as Topic; Registries; Stroke Volume; United States; Ventricular Dysfunction, Left

Topics: Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Adrenergic beta-Antagonists; Cardiotonic Agents; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Catecholamines; Digitalis; Diuretics; Emergencies; Heart Failure; Humans; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Shock, Cardiogenic; Vasodilator Agents

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

The efficacy and safety of cilazapril in chronic heart failure have been extensively investigated in an international clinical program in patients with underlying chronic heart failure with ischemic heart disease or dilated cardiomyopathy. Cilazapril in single doses of 1.25-5 mg produced a significant dose-dependent reduction in pulmonary capillary wedge pressure and systemic vascular resistance and a significant increase in cardiac index. In placebo-controlled studies, 1-5 mg of cilazapril once daily for 12 weeks prolonged predose exercise test duration and improved New York Heart Association classification status and signs and symptoms of chronic heart failure, including paroxysmal nocturnal dyspnea. Up to 86% of patients receiving these dosages had improvement, with only 12% of patients requiring the higher dose, 5 mg. These data indicate that cilazapril is effective when administered once daily to patients with chronic heart failure receiving concomitant therapy with digitalis and/or a diuretic. The safety of cilazapril in patients with chronic heart failure has been evaluated in 1,163 patients administered from 0.5 to 15 mg once daily for treatment periods ranging from 1 day to 57 months. Cilazapril was administered to 500 patients for at least 6 months, 264 patients for at least 1 year, and 101 patients for at least 2 years. The most frequently occurring adverse events were dizziness, coughing, dyspnea, fatigue, angina pectoris, and headache. Cilazapril was equally well tolerated by young and elderly patients. Treatment was discontinued due to adverse events in 12.9% of patients, mainly as a result of coughing (1.7%) and dizziness (1%). Forty-four patients (3.8%) died during cilazapril therapy or during a period without treatment. Of these deaths, 93% were due to cardiac causes, especially rhythm disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cardiomyopathy, Dilated; Cilazapril; Digitalis; Diuretics; Dose-Response Relationship, Drug; Double-Blind Method; Exercise Test; Female; Heart Failure; Hemodynamics; Humans; Male; Myocardial Ischemia; Plants, Medicinal; Plants, Toxic

The introduction of new drugs, and a re-evaluation of older drugs, have radically changed the pharmacological management of heart failure. Angiotensin converting enzyme (ACE) inhibitors, digitalis, diuretics and the combination of nitrates and hydralazine are now used. The first Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS I) and the second Vasodilator therapy in Heart Failure Trial (V-HeFT II) have demonstrated that patients with severe or advanced heart failure should be treated with ACE inhibitors, digitalis and diuretics (other vasodilators can be used if ACE inhibitors are contraindicated) to improve symptoms and duration of life. The Studies Of Left Ventricular Dysfunction (SOLVD) and the Munich Heart Failure trial have shown that patients with mild heart failure should be treated with ACE inhibitors. However, data from several large clinical registries suggest that only 40% of patients with heart failure are being given ACE inhibitors perhaps through fear of serious renal damage or hypotension; these fears are unfounded. Patients with anterior myocardial infarcts and reduced left ventricular function also benefit from ACE inhibitors. The fourth International Study of Infarct Survival (ISIS 4) and results from the Gruppo Italiano per Io Studio della Sopravvivenza nell'Infarto miocardico 3 (GISSI 3) have indicated that patients with acute myocardial infarction benefit from early ACE inhibitor therapy and that survival is increased. Heart failure treatment can be optimized by establishing a disease etiology and stressing the need to restrict dietary sodium. ACE inhibitors should be used for depressed left systolic ventricular function, including patients in New York Heart Association class I heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Calcium Channel Blockers; Captopril; Clinical Trials as Topic; Contraindications; Digitalis; Digoxin; Diuretics; Enalapril; Heart Failure; Humans; Hydralazine; Lisinopril; Nitrates; Plants, Medicinal; Plants, Toxic; Randomized Controlled Trials as Topic; Stroke Volume

Although an underlying disturbance in cardiac function can be identified in most patients with congestive heart failure, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. Until recently diuretic agents and digoxin formed the basis of conventional treatment of this condition. The majority of clinical trials published since 1980, indicate that digoxin lessens symptoms and reduces morbidity associated with congestive heart failure particularly in patients with more advanced symptoms and ventricular dysfunction. The efficacy of digitalis in congestive heart failure may in part result from sympathoinhibitory properties such as the activation of baroreceptorial mechanisms. At present there is no conclusive evidence that cardiac glycosides improve survival. Several trials clearly indicate that angiotensin converting enzyme inhibitors (enalapril, captopril) can reduce both morbidity and mortality in symptomatic congestive heart failure. Asymptomatic patients like those with severe left ventricular dysfunction and those who are at high risk for left ventricular remodeling after anterior wall myocardial infarction may also benefit from ACE-inhibition therapy. Increasing evidence suggests that beta-adrenergic blockade can produce symptomatic and hemodynamic improvement in heart failure of idiopathic and ischemic aetiology. Appropriately powered randomized controlled trials are required to determine the impact on survival of beta-blockers.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiotonic Agents; Controlled Clinical Trials as Topic; Digitalis; Diuretics; Follow-Up Studies; Heart Failure; Humans; Multicenter Studies as Topic; Phosphodiesterase Inhibitors; Placebos; Plants, Medicinal; Plants, Toxic; Randomized Controlled Trials as Topic; Risk Factors; Time Factors; Vasodilator Agents

Topics: Clinical Trials as Topic; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Renin-Angiotensin System

Topics: Aged; Digitalis; Diuretics; Heart Failure; Humans; Myocardial Ischemia; Plants, Medicinal; Plants, Toxic; Prognosis; Quality of Life; Vasodilator Agents

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

The immediate goal of management of heart failure is to improve cardiac function and eliminate symptoms. On the other hand, the final goal is to improve the quality of life and survival. In this chapter, general approaches to fulfill these goals are discussed. First, precise evaluation of the patient is necessary and the underlying cause of heart failure must be diagnosed. If possible, the underlying cause should be rectified. Precipitating factors, such as infection, should also be removed. Appropriate therapeutic measures are then selected according to the type and severity of heart failure. In pharmacotherapy, digoxin, diuretics and vasodilators are usually used in combination. In refractory heart failure, inotropic drugs, including sympatomimetic amines, are usually effective. Special measures including dialysis and assisted circulation, may also be considered in acute or refractory heart failure. Finally, management of ventricular arrhythmias in patients with heart failure is still controversial.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Diet, Sodium-Restricted; Digitalis; Diuretics; Exercise Therapy; Heart Failure; Heart Transplantation; Hemofiltration; Humans; Intra-Aortic Balloon Pumping; Plants, Medicinal; Plants, Toxic

Digitalis glycosides are the first-choice drugs in the treatment of the patients with congestive heart failure and atrial fibrillation. Recently, it has been shown that digitalis glycosides have potentially beneficial neurohumoral modulating effects by decreasing excessive neurohumoral responses directly or by improving baroreflex mechanisms in congestive heart failure. Accordingly, there are many investigators who believe that digitalis glycosides are neurohormonal modulating agents in heart failure. There may be a dissociation between hemodynamic and neurohormonal effects in response to digitalis glycosides. The activation of the neurohormonal system may be present in patients with asymptomatic left ventricular dysfunction. Digitalis glycosides may therefore be used, not only to improve symptomatic congestive heart failure, but also to protect against the progressive deterioration of asymptomatic cardiac dysfunction.

Topics: Atrial Natriuretic Factor; Digitalis; Digoxin; Heart Failure; Humans; Norepinephrine; Plants, Medicinal; Plants, Toxic; Renin

Although digitalis was introduced to medicine long ago, the drug is still extensively used in clinical practice today. Opinions on its mechanism of action have undergone much change in the course of time, and the way in which cardiovascular effects are produced is still not completely clear. Limitations and contraindications for the use of digitalis substances are reported, especially in the treatment of ischemic heart disease. Preliminary data regarding the effects of digitalis on the diastolic phase are unfavorable, although the relationship between digitalis and diastolic function ought to be studied in greater depth in various clinical conditions. In spite of many recent trials, the old question of the usefulness of digitalis in the chronic treatment of patients in sinus rhythm and heart failure is still debated. An important clinical benefit in the chronic use of digitalis appears restricted to a relatively small proportion of patients with severe congestive heart failure, while in the majority of chronically treated subjects the effects of the drug are scanty or insignificant. The beneficial effect of digitalis used chronically is essentially believed to be due to its positive inotropic action. Since the vagomimetic and the antiadrenergic effects of digitalis have been demonstrated to be independent from its inotropic action, they could be considered determinants of the clinical benefits of digitalis. These indirect effects may be useful in the control of the negative neuroendocrine response developing during congestive heart failure. Thus the statement that digitalis is essentially an inotropic agent seems restrictive; its definition should reflect the favorable effects obtained in some cases of congestive heart failure rather than its various and contrasting underlying mechanisms of action.

Topics: Contraindications; Digitalis; Digitalis Glycosides; Heart Failure; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic

Digitalis should be used for slowing a rapid ventricular rate in atrial fibrillation or atrial flutter unassociated with the preexcitation syndrome. Digitalis may be used to convert paroxysmal supraventricular tachycardia to sinus rhythm. Patients with the tachycardia-bradycardia syndrome should receive maintenance doses of digitalis after pacemaker implantation. Digitalis should not be used for treating CHF with normal LV systolic function unless a supraventricular tachyarrhythmia is present. Conflicting studies have been reported as to the efficacy of digoxin in the treatment of patients with CHF in sinus rhythm. Digoxin may be used for treating CHF with abnormal LV systolic function which does not respond to diuretics and ACE inhibitors or in patients unable to tolerate ACE inhibitor or other vasodilator therapy. Digitalis has a low toxic-therapeutic ratio, especially in elderly persons. Digoxin-specific Fab antibody fragments may be used for treating digitalis toxicity refractory to conventional measures with a treatment response in at least 90% of patients with advanced and potentially life-threatening digitalis toxicity.

Topics: Clinical Trials as Topic; Digitalis; Digoxin; Female; Heart Failure; Humans; Male; Plants, Medicinal; Plants, Toxic; Tachycardia, Supraventricular

Congestive heart failure (CHF) is a disorder characterized by a variety of clinical, biochemical, electrophysiological, and hemodynamic abnormalities. During the past two decades, numerous drugs have been employed in the treatment of this complex syndrome, and many agents have been shown to improve symptoms and ventricular function in patients with CHF. Because CHF is associated with a high risk of death, treatment should be directed not only toward the relief of symptoms, but also toward a reduction in mortality. Many variables have been shown to be related to survival; taken individually, however, each is limited in its utility in predicting prognosis. In recent years, large-scale studies with large sample sizes have directly assessed the effects of treatment on mortality in CHF. Results from these trials indicate that vasodilators and angiotensin-converting enzyme (ACE) inhibitors may improve mortality in patients with symptoms of heart failure. Additional trials are now in progress to evaluate the effect of treatment on patients with asymptomatic left ventricular dysfunction.

Topics: Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Cardiotonic Agents; Digitalis; Exercise Test; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic; Prognosis; Renin-Angiotensin System; Sympathetic Nervous System; Treatment Outcome; Vasodilator Agents; Ventricular Function, Left

The clinical literature on the subject of inotropic therapy of heart failure, particularly use of digitalis glycosides, is full of contradictions. Most of this disparity can be accounted for if not reconciled by taking the methodology of the clinical trials into consideration. Because drug interventions may produce subtle effects requiring a subjective determination, the questions being asked in these studies cannot be answered without removing as many sources of bias as possible from the patient management and data analysis. If a study has not been adequately randomized, double-blinded, and placebo-controlled, the clinical findings will be inconclusive at best. Systolic myocardial dysfunction plays a pivotal role in the pathogenesis of CHF in many patients and is a prerequisite for the use of cardiotonic drugs. Although the clinical signs of heart failure may be relieved initially by diuretics and vasodilators, compensation may require the addition of a positive inotrope, particularly in advanced cases. In veterinary medicine, the choice of positive inotrope is limited to digoxin, digitoxin, dobutamine, or amrinone. Digoxin possesses superior pharmacokinetics and is the cardiac glycoside of choice for use in the dog. Dobutamine and amrinone are more potent inotropes, but since they must be administered by continuous intravenous infusion, their use is limited to critical care therapy. At the present time, only digoxin can be administered orally for sustained long-term maintenance therapy. Milrinone, a more potent derivative of amrinone, also offers this option, but it has not been available since its brief trial debut as an investigational drug. None of the nonglycoside alternatives couples the benefits of positive inotropic and negative chronotropic effects. Consequently, digoxin remains the mainstay for chronic inotropic support of the heart. Atrial fibrillation with a rapid ventricular response rate is the prime indication for digoxin. In the last few years, evidence from methodologically sound clinical trials on humans has also restored faith in the efficacy of digoxin for treating heart failure in patients with normal sinus rhythm. From these studies, the profile of a digitalis responsive heart failure patient has emerged. Digoxin is most likely to be efficacious when heart failure is associated with chronic, severe ventricular systolic dysfunction, which has resulted in ventricular dilatation. The most reliable clinical marker is the presence of a t

Topics: Animals; Cardiotonic Agents; Catecholamines; Digitoxin; Digoxin; Dog Diseases; Dogs; Heart Failure; Humans; Phosphodiesterase Inhibitors

Digitalis has been used in the treatment of chronic congestive heart failure for 215 years. In this article, numerous clinical studies and trials that have evaluated the efficacy of digitalis in the treatment of patients with congestive heart failure are reviewed. The data indicate that digitalis is a valuable therapeutic agent for relieving symptoms and improving exercise performance and left ventricular function in patients with congestive heart failure. Comparison of the various advantages and disadvantages of digitalis with alternative therapies in patients with congestive heart failure shows an important continuing role for digitalis therapy.

Topics: Clinical Trials as Topic; Digitalis; Exercise Test; Heart Failure; Hemodynamics; Humans; Plants, Medicinal; Plants, Toxic; Ventricular Function, Left

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Death, Sudden; Digitalis; Diuretics; Heart Failure; Humans; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Aged; Digitalis; Diuretics; Female; Heart Failure; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic

Topics: Animals; Digitalis; Digitalis Glycosides; Drug Tolerance; Heart Failure; Humans; Myocardium; Plants, Medicinal; Plants, Toxic

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Chronic Disease; Digitalis; Diuretics; Heart Failure; Humans; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Aged; Aged, 80 and over; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

The angiotensin converting enzyme (ACE) inhibitors constitute a major breakthrough in the medical management of congestive heart failure. The incidence of side effects with these agents is surprisingly low when they are used in the appropriate dosage. They produce sustained beneficial hemodynamic and symptomatic improvement in most patients with congestive heart failure and may produce greater symptomatic benefit than digoxin when given as second-line therapy to patients with heart failure on diuretics. Their neurohumoral effects generally are advantageous, resulting in normalization of sodium and potassium balance and a reduction in ventricular arrhythmias. The ACE inhibitors may improve survival in patients with congestive heart failure, and recent data suggest that they may prevent or delay the development of left ventricular dilatation and overt heart failure in patients with asymptomatic left ventricular dysfunction.

Topics: Angiotensin-Converting Enzyme Inhibitors; Digitalis; Exercise; Heart Failure; Hemodynamics; Humans; Kidney; Plants, Medicinal; Plants, Toxic; Vasodilator Agents; Water-Electrolyte Balance

Topics: Digitalis; Digoxin; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

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

Although the etiology of congestive heart failure is complex, a disturbance of myocardial function due to ischemic heart disease or various forms of cardiomyopathy is by far the leading causative factor. In the early stages of failure various cardiac compensating mechanisms, such as hypertrophy, an increase in contractility and the Frank-Starling mechanism, prevent a major reduction in function. With ongoing failure, myocardial muscle function further deteriorates because of a disturbance in myocardial energy utilization, abnormalities in sympathetic neurotransmitter metabolism, a reduction in beta-receptor density, and, more importantly, a derangement of intracellular calcium transport. The subsequent reduction in cardiac output leads to activation of peripheral neurohumoral mechanisms, including sympathetic stimulation, an increase in circulating norepinephrine, stimulation of the renin-angiotensin-aldosterone system (RAAS), and increased arginine vasopressin production, which result in arterial and venous vasoconstriction, redistribution of tissue blood flow, and an increase in circulating blood volume. The adjustments, however, lead to a vicious circle, where heart function is further depressed by the increase in afterload, whereas the changes in the venous bed and the increase in circulating volume ultimately result in congestion. At this point, digitalis and diuretics alone are no longer sufficiently effective and vasodilators are indicated, possibly combined, in the later stages of failure, with positive inotropic drugs. The angiotensin converting-enzyme inhibiting agents seem particularly useful in this context, presumably because of their complex mode of action, interfering with the neurohumoral systems and peripheral vasculature at multiple sites. Particularly with these agents, a remarkable improvement in clinical condition and exercise capacity has been observed. Even so, the long-term prognosis in patients with severe congestive heart failure is still extremely poor with one-year mortality rates in New York Heart Association class III and IV patients ranging from 34% to 48%. In this article, the pathophysiology of congestive heart failure and the potential of drug therapy are further discussed.

Topics: Autonomic Nervous System; Blood Pressure; Calcium; Cardiomegaly; Cardiotonic Agents; Digitalis; Diuretics; Energy Metabolism; Heart; Heart Failure; Heart Rate; Humans; Myocardial Contraction; Myocardium; Nitrates; Plants, Medicinal; Plants, Toxic; Sodium; Sympathomimetics; Vasodilator Agents

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Anticoagulants; Calcium Channel Blockers; Cardiac Catheterization; Diet; Digitalis; Diuretics; Echocardiography; Electrocardiography; Exercise Test; Heart; Heart Failure; Heart Function Tests; Heart Transplantation; Heart-Assist Devices; Heart, Artificial; Humans; Kidney; Monitoring, Physiologic; Nitrates; Plants, Medicinal; Plants, Toxic; Sympathetic Nervous System; Sympathomimetics; Vasodilator Agents

Congestive heart failure is a clinical syndrome with inadequate cardiac output and increased venous pressure, characterized by hyperfunction of the sympatho-neuro-endocrine system, favoring maximal vasoconstriction in non-essential organs and retention of salt and water. Identification of the cause of heart failure and its correction is the best treatment. The suppression of precipitant factors is also essential. Traditionally the treatment of congestive heart failure is based on diuretics, restriction of salt intake, and digitalis. The conventional vasodilators are effective in the short term, but they have a marked tendency to tachyphylaxis. The inhibitors of angiotensin-converting enzyme are, through their specific action on neuro-endocrine dysregulation, the most important advance in recent years. Of the non-glycosidic inotropic agents used in severe heart failure, the new inhibitors of phosphodiesterase need further testing. In certain cases, permanent synchronous pacing has to be considered.

Topics: Angiotensin-Converting Enzyme Inhibitors; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Changes in the pharmacokinetics of antiarrhythmic agents should be expected in patients with congestive heart failure (CHF). The direction of the changes, however, is not always predictable. The volume of distribution is often decreased by as much as 40%, and loading doses should, therefore, be appropriately reduced. Drug clearance may also be diminished due to decreased blood flow to the liver and kidneys, as well as decreased hepatic drug-metabolizing activity. Infusion rates should similarly be lowered to avoid toxicity. However, decreases in both volume of distribution and clearance may result in little, if any, change in elimination half-life, despite higher plasma concentrations. On the other hand, the elimination half-life of antiarrhythmic agents that have a large volume of distribution and are highly cleared by the liver may be twice as long in patients with CHF compared with normal subjects. Thus, the total daily dose of drug should also be lower in these patients. In addition, the time necessary to reach steady state is longer, so that premature dose escalation may lead to excessive drug accumulation. In terms of their pharmacodynamic effects, all antiarrhythmic agents have the potential to manifest a degree of negative inotropy, which must be anticipated as a possible side effect in patients with CHF. Some of the newer agents, such as tocainide and encainide, appear to cause only minimal myocardial depression. Other potential complications of all antiarrhythmic therapy include proarrhythmia and possible drug interactions with digitalis and diuretics.

Topics: Amiodarone; Anilides; Anti-Arrhythmia Agents; Digitalis; Disopyramide; Drug Interactions; Encainide; Flecainide; Half-Life; Heart Failure; Hemodynamics; Humans; Kidney; Kinetics; Lidocaine; Liver; Piperidines; Plants, Medicinal; Plants, Toxic; Potassium; Procainamide; Quinidine; Regional Blood Flow; Tocainide

Congestive heart failure (CHF) represents a pathophysiologic state in which cardiac output is inadequate to meet the metabolic needs of multiple organ systems. The primary pathologic event in CHF is a marked, sustained reduction in the intrinsic contractility of the heart. A review of the current knowledge regarding the etiology and progression of CHF reveals that it is associated with profound biochemical, peripheral hemodynamic (increased peripheral vascular resistance), and electrolyte disturbances. In addition to sodium and water retention, CHF is often associated with hypokalemia and hypomagnesemia as well as tissue deficits in K and Mg. Cardiac glycosides and diuretics (loop and distal types) often exacerbate, or result in, hypokalemia and hypomagnesemia, which may lead to cardiac arrhythmias and sudden cardiac death. Deficits in extracellular and vascular tissue Mg lead to peripheral vasoconstriction; this together with K deficits and the release of neurohumoral substances may be responsible in large measure for the increase in peripheral vascular resistance commonly noted in CHF. More attention must be paid to the careful monitoring of electrolyte levels (Na, K, Mg) in tissues (possibly lymphocytes) and plasma of CHF patients. Deficits in either K or Mg must be corrected in CHF. The nonspecific vasodilator properties of Mg2+ together with its ability to unload the heart should be considered as an important adjunct tool in the management of CHF.

Topics: Adenosine Triphosphate; Calcium; Coronary Disease; Digitalis; Heart Failure; Humans; Magnesium; Magnesium Deficiency; Myocardial Contraction; Myocardium; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Potassium; Sodium; Vasopressins

Digitalis glycosides continue to place high on the list of prescribed drugs. Digoxin is 8th on prescriptions written in the United States in 1980, digitoxin 16th, and digitalis leaf 23rd. There is little doubt that most physicians continue to believe these drugs are useful. The application of more definite indications, smaller doses, and the recognition of the role of pharmacokinetics and drug interactions make use of the glycosides more challenging than ever before in 1985.

Topics: Administration, Oral; Adrenergic beta-Antagonists; Age Factors; Anti-Arrhythmia Agents; Antihypertensive Agents; Arrhythmias, Cardiac; Biological Availability; Bretylium Tosylate; Deslanoside; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Drug Interactions; Heart Failure; Humans; Injections, Intramuscular; Injections, Intravenous; Intestinal Absorption; Kidney Failure, Chronic; Lidocaine; Metabolic Clearance Rate; Myocardial Infarction; Obesity; Phenytoin; Potassium; Pulmonary Heart Disease; Thyroid Diseases

Topics: Adult; Cesarean Section; Digitalis; Drug Therapy, Combination; Electric Countershock; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Heart Failure; Heart Rate; Humans; Hypertension; Infant, Newborn; Labor, Induced; Male; Plants, Medicinal; Plants, Toxic; Pregnancy; Pregnancy Complications, Cardiovascular; Propranolol; Tachycardia; Ultrasonography; Verapamil

Topics: Biological Transport; Cardiac Output; Cardiotonic Agents; Chronic Disease; Digitalis; Diuretics; Exercise Test; Heart Failure; Humans; Oxygen; Plants, Medicinal; Plants, Toxic; Syndrome; Vasodilator Agents

Topics: Cardiac Glycosides; Chemical Phenomena; Chemistry; Digitalis; Digitalis Glycosides; Drug Interactions; Heart; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Use of digitalis for the treatment of patients with congestive heart failure and sinus rhythm remains controversial. To ascertain the proper therapeutic role of digitalis, we have critically appraised the published clinical evidence of digitalis efficacy using standardized methodologic criteria. A search of the English literature from 1960 to 1982 identified 736 articles, of which 16 specifically addressed the clinical evaluation of digitalis therapy for patients with congestive heart failure and sinus rhythm. Only two double-blind, placebo-controlled trials provided clinically useful information. One study showed that digoxin therapy could be withdrawn successfully in elderly patients with stable congestive heart failure. The other showed that patients with chronic heart failure and an S3 gallop benefited from digoxin therapy.

Topics: Clinical Trials as Topic; Digitalis; Digitalis Glycosides; Digoxin; Diuretics; Drug Therapy, Combination; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Pulmonary Heart Disease; Research Design

Although digitalis glycosides were introduced for the treatment of cardiac disorders almost 200 years ago, controversy persists regarding the relative role of these inotropic agents, particularly in patients with coronary artery disease in sinus rhythm. With the advent of more potent diuretics and the demonstrated benefit of vasodilators in left ventricular unloading, the relative worth of digitalis in patients with coronary artery disease and myocardial infarction is being re-examined.

Topics: Angina Pectoris; Arrhythmias, Cardiac; Clinical Trials as Topic; Coronary Disease; Coronary Vessels; Digitalis; Heart Failure; Humans; Myocardial Infarction; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Substance Withdrawal Syndrome; Vascular Resistance

Topics: Arrhythmias, Cardiac; Blood Pressure; Creatine Kinase; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Heart Failure; Humans; Myocardial Contraction; Myocardial Infarction; Oxygen Consumption

Topics: Animals; Digitalis; Digitalis Glycosides; Diuresis; Drug Interactions; Heart Failure; Hemodynamics; Humans; Kinetics; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Prognosis; Quinidine

Topics: Adult; Aged; Biological Availability; Blood Proteins; Digitalis Glycosides; Digitoxin; Digoxin; Female; Heart Failure; Humans; Intestinal Absorption; Kidney; Kinetics; Male; Middle Aged; Protein Binding

Topics: Digitalis; Diuretics; Heart; Heart Failure; Hemodynamics; Humans; Myocardial Contraction; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Stimulation, Chemical

Recent intoxication studies during digitalis therapy have shown that digoxin and digitoxin produce different pharmakokinetic results. The main difference is in the elimination pathways of the two substances. Whereas digoxin is almost exclusively excreted by the kidneys, digitoxin may be excreted both by the kidneys and by the intestine via the bile. New dosage guidelines have resulted from these studies. The problems of adjustment by means of instrumental parameters are presented and the need for individual dosage on the least effective dose principle is discussed.

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Dosage Forms; Dose-Response Relationship, Drug; Heart Failure; Humans; Kidney; Liver

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Radioimmunoassay

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Glomerular Filtration Rate; Heart Failure; Humans; Kidney Failure, Chronic

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Intestinal Absorption

Topics: Arrhythmias, Cardiac; Delirium; Depression; Digitalis Glycosides; Digitoxin; Digoxin; Hallucinations; Heart Failure; Humans; Vision Disorders

Topics: Acid-Base Imbalance; Aged; Atropine; Cardiac Complexes, Premature; Digitalis Glycosides; Digitoxin; Digoxin; Drug Interactions; Heart Block; Heart Failure; Heart Ventricles; Humans; Kidney Failure, Chronic; Phenytoin; Potassium; Tachycardia

Topics: Angina Pectoris; Arrhythmias, Cardiac; Biological Availability; Cardiac Glycosides; Central Nervous System Diseases; Digitoxin; Digoxin; Endocrine System Diseases; Gastrointestinal Diseases; Heart Failure; Humans; Hypersensitivity; Hypertension; Intestinal Absorption; Myocardial Infarction; Preoperative Care

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Drug Interactions; Heart Failure; Humans; Hyperthyroidism; Hypothyroidism; Intestinal Absorption; Kidney Failure, Chronic; Molecular Conformation; Obesity

The pharmacokinetics of the cardiac glycofides have been elucidated as a result of the development of assays of sufficient sensitivity to measure the concentration of digitalis compounds in biological fluids. Digoxin can accumulate in the body without the administration of a loading dose, and a steady state blood concentration will be reached in 5 to 7 days. Digitoxin requires 35 days to accumulate to a plateau. If a loading dose of digoxin is used, it should be approximately three times the estimated daily maintenance dose. Factors that determine the selection of the appropriate maintenance dose of digoxin include renal function and lean body mass. Digitoxin is less dependent on renal function for its elimination than is digoxin. Knowledge of the pharmacokinetics of digitalis preparations is useful in determining how to change from one cardiac glycoside to another, each with different half-lives. One should wait 3 days before starting digoxin therapy when changing from maintenance digitoxin to digoxin (assuming normal renal function). The pharmacokinetics of changing from ouabain to digoxin without loss of digitalis effect are described. The metabolism of the commonly used digitalis preparations are summarized.

Topics: Atrial Fibrillation; Creatinine; Delayed-Action Preparations; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Feces; Half-Life; Heart Failure; Humans; Kidney; Kinetics; Ouabain; Time Factors

Topics: Administration, Oral; Aged; Digitalis Glycosides; Digitoxin; Digoxin; Feces; Heart Atria; Heart Failure; Humans; Injections, Intramuscular; Injections, Intravenous; Intestinal Absorption; Kidney Diseases; Liver Diseases; Malabsorption Syndromes; Obesity; Tachycardia; Thyroid Diseases; Tritium; Water-Electrolyte Balance

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Drug Therapy; England; Heart Failure; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Intestinal Absorption; Molecular Conformation; Protein Binding

Topics: Age Factors; Creatinine; Diet; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Heart Failure; Humans; Hypercalcemia; Hypokalemia; Kidney; Kinetics; Liver; Magnesium; Ouabain; Plants, Medicinal; Plants, Toxic; Rest; Thyroid Gland; Time Factors

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: Adenosine Triphosphatases; Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Digoxin; Heart; Heart Failure; Heart Rate; Humans; Kidney Diseases; Kinetics; Lanatosides; Lidocaine; Myocardium; Pacemaker, Artificial; Phenytoin; Potassium; Procainamide; Propranolol; Quinidine; Thyroid Diseases

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Tachycardia, Paroxysmal

Topics: Cardiac Output; Catecholamines; Digitalis Glycosides; Digitoxin; Digoxin; Dopamine; Glucagon; Heart; Heart Failure; Humans; Isoproterenol; Myocardial Infarction; Norepinephrine

Topics: Adolescent; Adult; Aged; Angiocardiography; Aortic Valve Insufficiency; Cardiomegaly; Child; Child, Preschool; Diet, Sodium-Restricted; Digitalis; Diuretics; Endocarditis, Subacute Bacterial; Heart Failure; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Infant, Newborn; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pulmonary Circulation; Pulmonary Valve Stenosis

Topics: Adams-Stokes Syndrome; Adolescent; Adult; Bradycardia; Cardiomegaly; Child; Child, Preschool; Digitalis; Europe; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Isoproterenol; Pacemaker, Artificial; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Tachycardia; United States

Topics: Arrhythmias, Cardiac; Creatinine; Digitoxin; Digoxin; Heart Failure; Humans; Intestinal Absorption; Protein Binding; Time Factors

Topics: Animals; Anura; Biological Assay; Cats; Chemistry, Pharmaceutical; Chromatography, Paper; Columbidae; Digitalis; Digitalis Glycosides; Guinea Pigs; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

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: Digitalis; Digitalis Glycosides; Disease Management; Drug Therapy; Heart Failure; Humans

Topics: Cardiac Tamponade; Child; Congenital Abnormalities; Digitoxin; Diuretics; Dyspnea; Emergencies; Heart Failure; Humans; Infant; Lanatosides; Shock; Strophanthins; Thrombosis; Vascular Diseases

Topics: Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digitalis; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Block; Heart Failure; Humans; Isoproterenol; Lanatosides; Mitral Valve Stenosis; Pacemaker, Artificial; Tachycardia; Thoracic Surgery; Toxicology; Ventricular Fibrillation

Topics: Aldosterone; Digitalis; Digitalis Glycosides; Diuretics; Edema; Electrolytes; Heart Failure; Hypokalemia; Physiology; Potassium; Sodium; Toxicology; Vasopressins

Topics: Acetazolamide; Digitalis; Digitalis Glycosides; Diuretics; Heart; Heart Failure; Humans; Metabolism; Mineralocorticoid Receptor Antagonists; Organomercury Compounds; Physiology; Sodium; Triamterene; Water; Xanthines

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart Failure; Hemodynamics; Humans; Mitral Valve Stenosis; Ventricular Dysfunction, Right

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Postoperative Period; Surgical Procedures, Operative

Topics: Aldosterone; Blood Chemical Analysis; Blood Proteins; Body Fluids; Capillary Permeability; Carbon Dioxide; Chlorides; Digitalis; Digitalis Glycosides; Heart Failure; Hydrogen-Ion Concentration; Kidney; Lactates; Liver; Metabolism; Muscles; Physiology; Pyruvates; Sodium; Water-Electrolyte Balance

Despite recent advances in the treatment of chronic heart failure (HF), mortality and hospitalizations still remain high. Additional therapies to improve mortality and morbidity are urgently needed. The efficacy of cardiac glycosides - although regularly used for HF treatment - remains unclear. DIGIT-HF was designed to demonstrate that digitoxin on top of standard of care treatment improves mortality and morbidity in patients with HF and a reduced ejection fraction (HFrEF).. Patients with chronic HF, New York Heart Association (NYHA) functional class III-IV and left ventricular ejection fraction (LVEF) ≤ 40%, or patients in NYHA functional class II and LVEF ≤ 30% are randomized 1:1 in a double-blind fashion to treatment with digitoxin (target serum concentration 8-18 ng/mL) or matching placebo. Randomization is stratified by centre, sex, NYHA functional class (II, III, or IV), atrial fibrillation, and treatment with cardiac glycosides at baseline. A total of 2190 eligible patients will be included in this clinical trial (1095 per group). All patients receive standard of care treatment recommended by expert guidelines upon discretion of the treating physician. The primary outcome is a composite of all-cause mortality or hospital admission for worsening HF (whatever occurs first). Key secondary endpoints are all-cause mortality, hospital admission for worsening HF, and recurrent hospital admission for worsening HF.. The DIGIT-HF trial will provide important evidence, whether the cardiac glycoside digitoxin reduces the risk for all-cause mortality and/or hospital admission for worsening HF in patients with advanced chronic HFrEF on top of standard of care treatment.

Topics: Cardiotonic Agents; Cause of Death; Chronic Disease; Digitoxin; Double-Blind Method; Heart Failure; Hospitalization; Humans; Mortality

Digoxin is recommended in symptomatic heart failure patients with reduced ejection fraction (HF-REF) in sinus rhythm and refractory to other evidence-based therapy. Although HF-REF patients with diabetes have worse functional status than those without, the effects of digoxin have not been specifically evaluated according to diabetes status.. We examined the efficacy and safety of digoxin in HF-REF patients with and without diabetes in the Digitalis Investigation Group trial. Mortality from all-cause, cardiovascular (CV) causes and heart failure (HF), along with HF hospitalisation and suspected digoxin toxicity were analyzed according to diabetes status and randomised treatment assignment.. Of the 6800 patients, those with diabetes (n=1933) were older, more often women, had worse clinical status and more co-morbidity than those without diabetes. All-cause and CV mortality were higher in patients with diabetes than in those without and digoxin did not reduce mortality in either sub-group. The rate of HF hospitalization (per 100 person-years) in patients with diabetes was higher than in those without and was reduced by digoxin in both patient groups: diabetes - placebo 20.5 and digoxin 16.0 (HR 0.79, 95% CI: 0.68-0.91); no diabetes - placebo 12.7 and digoxin 8.7 (HR 0.69, 0.62-0.77); interaction p=0.14. Suspected digoxin toxicity in patients randomised to digoxin was more common among patients with diabetes than without (6.5% versus 5.8%), as was hospitalisation for digoxin toxicity (1.4% versus 0.8%).. Added to an ACE inhibitor, digoxin reduced HF hospitalisation in HF-REF patients with and without diabetes without a substantial risk of toxicity.

Topics: Aged; Cardiotonic Agents; Diabetes Mellitus; Digitalis; Digoxin; Female; Heart Failure; Hospitalization; Humans; Hyperkalemia; Male; Middle Aged; Retrospective Studies; Risk Factors; Stroke Volume; Treatment Outcome

A programme of four phase III clinical trials carried out in the USA on 1094 patients showed that Carvedilol, associated with the usual bitherapy and eventually with digitalis, reduced the mortality and number of hospital admissions of patients with cardiac failure. These results, transposed to the French population, may be used to evaluate the economic advantages of Carvedilol by developing a cost-effectiveness study which consists in relating the direct expenses (drugs and hospital admissions) of each of the two strategies, with or without Carvedilol, to their respective mortalities. Hospital expenses were estimated with respect to the H.M.G. corresponding to each hospital stay at 1997-1998 values. The cost in the Carvedilol group was 2,823 FF per patient (including 1,491 FF for the drug itself) but 2,056 FF were economised in hospital expenses. With an increased cost of 767 FF but a 50% reduction in mortality corresponding to a difference in mortality of 45@1000, the cost-effectiveness of Carvedilol was 17,040 per life saved and 2,130 FF per additional year of life expectancy. A study of the sensitivity produced even more favourable results of Carvedilol. An evaluation of hospital expenses on the basis of AP-HP data indicates that the addition of Carvedilol is associated with a 4,425 FF reduction in hospital expenses, which makes it a cost saving strategy.

Topics: Adrenergic beta-Antagonists; Carbazoles; Carvedilol; Cost-Benefit Analysis; Digitalis; Economics, Hospital; France; Heart Failure; Humans; Life Expectancy; Phytotherapy; Plants, Medicinal; Plants, Toxic; Propanolamines; Time Factors

Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure.. To determine whether chronic digitalization alters left ventricular function and performance.. Eighty patients with mild-to-moderate systolic heart failure (baseline ejection fraction < or =45%) participated from our institution in a multi-center, chronic, randomized, double-blind study of digitalis vs. placebo. Of the 40 survivors, 38 (20 allocated to the digitalis arm and 18 to the placebo arm) were evaluated at the end of follow-up (mean, 48.4 months). Left ventricular systolic function was assessed by both nuclear ventriculography and echocardiography. The ejection fraction was measured scintigraphically, while the ventricular volumes were computed echocardiographically.. The groups did not differ, at baseline or end-of-study, with respect to the ejection fraction and the loading conditions (arterial pressure, ventricular volumes and heart rate) by either intention-to-treat or actual-treatment-received analysis. Over the course of the trial, the digitalis arm exhibited no significant increase in the use of diuretics (18%, P=0.33), in distinction from the placebo group (78%, P=0.004), and a longer stay on study drug among those patients who withdrew from double-blind treatment (28.6 vs. 11.4 months, P=0.01).. Following chronic use of digitalis for mild-to-moderate heart failure, cross-sectional comparison with a control group from the same inception cohort showed no appreciable difference in systolic function or performance. Thus, the suggested clinical benefit cannot be explained by an inotropic effect.

Topics: Aged; Algorithms; Cardiac Glycosides; Digitalis; Double-Blind Method; Female; Heart Failure; Humans; Male; Middle Aged; Systole; Ventricular Function, Left

Topics: Angiotensin-Converting Enzyme Inhibitors; Digitalis; Diuretics; Double-Blind Method; Drug Therapy, Combination; Follow-Up Studies; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Plants, Medicinal; Plants, Toxic; Risk Factors; Spironolactone; Time Factors

The effects of digitoxin and/or diuretic agents were investigated in patients with congestive heart failure (CHF) in sinus rhythm with respect to changes in hemodynamic parameters, cardiac dimensions, and bicycle ergometric exercise capacity. In a randomized, double-blind study 16 male patients with CHF NYHA class II and III received a placebo for 1 week (baseline) and then were randomly allocated, double blind, to take either digitoxin (digitalis group, DI: N = 8) or trichlormethiazide/amiloride (diuretic group, DG: N = 8) for 3 weeks (VP I). The patients who were first treated with digitoxin received the diuretic agent for a further 3 weeks and vice versa (VP II). At baseline and after VP I and II, a physical examination, two-dimensional echocardiography, and bicycle ergometry were performed. Heart rate (HR), systolic (BPs), and diastolic (BPd) blood pressure at rest, and BPs and 50 watts, were not significantly changed during the observation period. HR at 50 watts was decreased in DI (11.5 +/- 10.1 beats/min.) after VP I and II, but not in DG. BPd was significantly reduced after VP II in DI (8.2 +/- 4.6 mmHg) and in DG (9.3 +/- 8.9 mmHg). DI presents at baseline significantly higher end-diastolic (LVEDV) and end-systolic (LVESV) left ventricular dimensions, whereas left atrial diameter (LA) and stroke volume (SV) and ejection fraction (LVEF) were not significantly different. After VP I, a significantly decreased LA was found in DI, but not in DG. After VP II, all cardiac dimensions were significantly reduced compared with the baseline in DI, whereas in DG only a decrease in LVESV was found. SV was significantly increased in DI, but not in DG after VP I, SV and LVEF were significantly improved in DI and in DG after VP II. Exercise capacity did not change significantly in DI and DG. Digitoxin in combination with trichlormethiazide/amiloride is effective in reducing primarily enlarged left atrial and left ventricular dimensions, and is sufficient to improve the impaired systolic left ventricular function in CHF of NYHA class II and III in sinus rhythm. However, a significant increase in exercise capacity was not found. Treatment with digitoxin seems to be more relevant as a monotherapy with trichlormethiazide/amiloride.

Topics: Aged; Amiloride; Anti-Arrhythmia Agents; Blood Pressure; Digitoxin; Diuretics; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Exercise Test; Heart Failure; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Placebos; Stroke Volume; Trichlormethiazide; Ventricular Function, Left

The efficacy and safety of cilazapril in chronic heart failure have been extensively investigated in an international clinical program in patients with underlying chronic heart failure with ischemic heart disease or dilated cardiomyopathy. Cilazapril in single doses of 1.25-5 mg produced a significant dose-dependent reduction in pulmonary capillary wedge pressure and systemic vascular resistance and a significant increase in cardiac index. In placebo-controlled studies, 1-5 mg of cilazapril once daily for 12 weeks prolonged predose exercise test duration and improved New York Heart Association classification status and signs and symptoms of chronic heart failure, including paroxysmal nocturnal dyspnea. Up to 86% of patients receiving these dosages had improvement, with only 12% of patients requiring the higher dose, 5 mg. These data indicate that cilazapril is effective when administered once daily to patients with chronic heart failure receiving concomitant therapy with digitalis and/or a diuretic. The safety of cilazapril in patients with chronic heart failure has been evaluated in 1,163 patients administered from 0.5 to 15 mg once daily for treatment periods ranging from 1 day to 57 months. Cilazapril was administered to 500 patients for at least 6 months, 264 patients for at least 1 year, and 101 patients for at least 2 years. The most frequently occurring adverse events were dizziness, coughing, dyspnea, fatigue, angina pectoris, and headache. Cilazapril was equally well tolerated by young and elderly patients. Treatment was discontinued due to adverse events in 12.9% of patients, mainly as a result of coughing (1.7%) and dizziness (1%). Forty-four patients (3.8%) died during cilazapril therapy or during a period without treatment. Of these deaths, 93% were due to cardiac causes, especially rhythm disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cardiomyopathy, Dilated; Cilazapril; Digitalis; Diuretics; Dose-Response Relationship, Drug; Double-Blind Method; Exercise Test; Female; Heart Failure; Hemodynamics; Humans; Male; Myocardial Ischemia; Plants, Medicinal; Plants, Toxic

We describe the results of two placebo-controlled trials (MIL-1077 and MIL-1078) designed to evaluate the clinical efficacy of oral milrinone administered together with converting enzyme inhibitors to patients with congestive heart failure. Although these trials were terminated prematurely, they provide the only controlled data regarding the effect of oral milrinone on exercise capacity in patients receiving converting enzyme inhibitors. Of the 254 patients randomized, 140 completed one of the trials or reached an end point and are the basis of this report. In both trials, there was a clear trend for an increase in exercise capacity in the milrinone-treated patients (+26 +/- 8% vs. +5 +/- 7% in MIL-1077 and +11 +/- 5% vs. +2 +/- 4% in MIL-1078). Symptoms of congestive heart failure were decreased in one trial but not the other. Quality of life, as assessed by a questionnaire, was not effected in either trial. There was an increased incidence of adverse events in milrinone-treated patients. Adverse events related primarily to hypotension and vasodilation led to discontinuation of drug in 18 milrinone-treated patients vs. 1 placebo-treated patient. Milrinone had little or no proarrhythmic effect and cardiovascular deaths were distributed equally between the milrinone and placebo groups. These data suggest that when used in combination with a converting enzyme inhibitor, oral milrinone improves exercise capacity but is associated with a high incidence of adverse events that appear to be related to excessive vasodilation.

Topics: Angiotensin-Converting Enzyme Inhibitors; Digitalis; Double-Blind Method; Drug Therapy, Combination; Electrocardiography, Ambulatory; Exercise Test; Female; Heart Failure; Humans; Male; Middle Aged; Milrinone; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Pyridones; Time Factors; United States

To analyze the physical performance of the patients with congestive heart failure (CHF), grades I and II of the New York Heart Association (NYHA), submitted to ergometric test: 1) under conventional treatment with digitalis and diuretic; 2) with an angiotensin converting enzyme inhibitor, captopril, associate with conventional treatment; 3) using captopril associated with digitalis or diuretic.. A randomized double blind study was performed in 20 patients with CHF (I and II-NYHA) submitted to ergometric test in different therapeutic phases. The initial workload was 5 watts and load was increased until the appearance of limiting symptoms.. The introduction of captopril to the conventional treatment for CHF or associated with digitalis or diuretic promotes significant increase in the duration of the physical exercise, in the oxygen consumption and in the total workload during the ergometric test.. In the initial forms of CHF, captopril provides better physical performance when compared with conventional treatment and the diuretic treatment can be changed for the angiotensin converting enzyme inhibitor with equal efficacy.

Topics: Analysis of Variance; Captopril; Chronic Disease; Digitoxin; Double-Blind Method; Drug Therapy, Combination; Exercise Test; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged

Topics: Adult; Aged; Clinical Trials as Topic; Digitoxin; Female; Heart Failure; Humans; Male; Middle Aged

Sixteen patients in heart failure and sinus rhythm were, after a four-week treatment-free period, randomly assigned to receive, for four to six weeks, either a diuretic combination (hydrochlorothiazide + triamterene) or a digitalis glycoside. Subsequently the treatment was exchanged between the two groups. Without treatment nine patients were in stage II (New York Heart Association classification), seven in stage III. Pulmonary wedge pressure at rest was 27 +/- 14, on exercise 32 +/- 8 mm Hg, cardiac output 5.3 +/- 1.0 at rest and 7.8 +/- 2.3 l/min on exercise. Digitalis glycosides improved symptoms by one stage in three of 16 patients. All objective measures showed slight but not significant improvement. Diuretic treatment improved symptoms in five patients, while heart size and echocardiographically measured ventricular volume decreased slightly. Cardiac output decreased at rest, but not significantly, and on exercise not at all. Pulmonary arterial pressure (21 +/- 9 mm Hg), pulmonary wedge pressure (13 +/- 7 mm Hg) and pulmonary artery pressure on exercise (39 +/- 11 mm Hg) were significantly lower on diuretics than without treatment. The results support the primary use of diuretics in the treatment of chronic heart failure.

Topics: Aged; Chronic Disease; Digitalis Glycosides; Digitoxin; Digoxin; Drug Combinations; Drug Evaluation; Female; Heart Failure; Hemodynamics; Humans; Hydrochlorothiazide; Male; Middle Aged; Time Factors; Triamterene

Twenty patients with moderately severe congestive heart failure were randomized to chronic enoximone (n = 10) or placebo (n = 10) therapy in a double-blind manner and serially evaluated over a 16-week-period. The purpose of the study was to determine if the addition of standard doses (1 and 2 mg/kg) of this new phosphodiesterase inhibitor to conventional therapy (digitalis and diuretics) would alter the clinical and laboratory course of this patient population. Except for a transient improvement in the quality of life score, none of the symptomatology indicators were significantly affected by enoximone. Similarly, maximal exercise capacity was not altered. Enoximone did elicit a statistically significant augmentation of echocardiographic, radionuclide angiographic, and systolic time interval parameters of left ventricular function. These enoximone-induced effects were accompanied by a significant increase (7% to 11%) in resting heart rate. Enoximone is capable of improving ventricular function when added to digitalis-diuretic therapy in moderately severe congestive heart failure. While individual patients may benefit from enoximone, the ability of standard doses of this agent to improve symptoms and exercise capacity over a 16-week period appears somewhat limited in a moderately severe heart failure population as a whole. Furthermore, a disparity between improvement in ventricular function parameters and changes in clinical status and exercise performance is apparent in this heart failure population.

Topics: Adult; Aged; Clinical Trials as Topic; Digitalis; Diuretics; Double-Blind Method; Drug Therapy, Combination; Enoximone; Exercise Test; Female; Heart Failure; Heart Ventricles; Hemodynamics; Humans; Imidazoles; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Random Allocation

A randomized, crossover, single-blind study compared the efficacy and dosing accuracy of digoxin and digitoxin in 15 ambulatory patients wth congestive heart failure. Loading doses and maintenance doses were calculated according to published equations that adjust for sex, height, and lean body weight (for digitoxin), plus estimated creatinine clearance (for digoxin). At each 2-week visit, serum drug concentrations were measured and compliance with the prescribed regimen was assessed by tablet count. At the end of each study period, a congestive heart failure (CHF) score was determined in a blinded fashion by the same physician. Patient compliance was unusually high (greater than or equal to 80%) at every visit. Therapeutic concentrations were achieved with digoxin and digitoxin in 5 and 14 patients, respectively (p less than 0.05). During digitoxin therapy, CHF scores were lower than pretreatment values (p less than 0.05). The difference between CHF scores during the digoxin and digitoxin periods did not achieve significance (0.05 less than p less than 0.06). Therapeutic serum concentrations can be achieved more easily and frequently with digitoxin than digoxin without compromising the patient's CHF status.

Topics: Adult; Aged; Clinical Trials as Topic; Digitoxin; Digoxin; Female; Heart Failure; Humans; Male; Middle Aged; Random Allocation

Topics: Clinical Trials as Topic; Coronary Disease; Digitalis; Heart Failure; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Prognosis; Random Allocation; Statistics as Topic

To study the efficacy of chronic digitalis therapy in patients with congestive heart failure and sinus rhythm, a bibliographic search was fulfilled. 12 clinical trials were found and analyzed from a clinical and methodological point of view. These studies have shown a discrepancy between the clinical and haemodynamic efficacy of the drug. Usually patients' symptoms don't improve as it should be expected from the haemodynamic data. It is possible and advisable to withdraw a chronic treatment in many stable patients without worsening the clinical conditions. However some methodological bias (research strategies, patient selections, follow-up analysis and clinical and haemodynamic criteria) seem to reduce the results' reliability. The old question of digitalis efficacy in sinus rhythm is still controversial: new inotropic drugs are appearing. The lesson from the digitalis controversy should be seriously considered in the clinical evaluation of these new therapeutic agents.

Topics: Clinical Trials as Topic; Digitalis; Digitalis Glycosides; Heart Failure; Heart Rate; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic

The influence of digitalis therapy on survivors of acute myocardial infarction was examined in the placebo-treated patients from the Beta-Blocker Heart Attack Trial (BHAT). Two hundred fifty (13%) of the 1,921 placebo-treated patients were receiving digitalis at the time of randomization. Patients receiving digitalis differed from those not receiving digitalis in such baseline characteristics as age, prior history of heart failure, prior myocardial infarction and angina pectoris. They also experienced a higher proportion of in-hospital complications including pulmonary edema, persistent hypotension, atrial fibrillation and heart failure in addition to a greater prevalence of complex ventricular premature beats. The total mortality rate over a mean 25 month follow-up period for digitalis-treated patients was 20.4% compared with 8.2% for patients not receiving digitalis; the odds ratio was 2.87 (p less than 0.05). When the mortality rates were adjusted for heart failure and ventricular premature beat complexity, patients receiving digitalis again demonstrated a higher mortality rate, although the adjusted odds ratio was now lower (1.70). When the patients receiving or not receiving digitalis were compared by a multiple logistic regression analysis adjusting for 17 independent variables predictive of mortality, the use of digitalis was no longer independently predictive of total mortality (adjusted odds ratio 1.07). These data indicate that patients receiving digitalis had more extensive cardiovascular disease and greater morbidity than patients not receiving digitalis. Their subsequent higher mortality rate was probably related to these factors rather than to digitalis therapy.

Topics: Adult; Aged; Blood Pressure; Digitalis; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Random Allocation

The effect of nifedipine (N) on the pharmacokinetics and pharmacodynamics of beta-acetyldigoxin (AD; n = 11) and digitoxin (DGT; n = 10) was studied in 21 patients with cardiac insufficiency stage II-III NYHA. Glycoside plasma concentration and renal excretion as well as electrocardiogram heart rate, atrioventricular transconduction time (PQ), duration of electrical systole corrected for heart rate (QTc), mean amplitude of T waves in leads V2 to V6 (TV2-6) and systolic time intervals total electromechanical systole index (QS21), left ventricular ejection time index (LVETI), pre-ejection period index (PEPI), PEP/LVET-ratio were recorded repeatedly before and during co-administrations of 40-60 mg/day N. Plasma AD concentrations were 0.64 +/- 0.22 ng/ml (mean +/- SD) before and 0.61 +/- 0.21 ng/ml during co-administration of N over 10-14 days, plasma DGT concentrations 13.9 +/- 4.1 ng/ml before and 13.7 +/- 4.5 ng/ml during co-administration of N over 4-6 weeks. Daily glycoside excretion was not affected by treatment with N. Heart rate and PQ-interval were not significantly changed during co-administration of N whereas T-wave flattening was intensified and QT-duration was lengthened. Concomitant treatment of AD and N led to an increase of PEPI and PEP/LVET compared to AD alone in ten patients whereas the systolic time intervals after concomitant treatment of DGT and N in most patients did not differ from those after DGT alone. From our findings we conclude that N had no clinically significant effect on pharmacokinetics and pharmacodynamics of AD or DGT.

Topics: Acetyldigitoxins; Aged; Digitoxin; Drug Therapy, Combination; Electrocardiography; Female; Heart Conduction System; Heart Failure; Heart Rate; Humans; Male; Metabolic Clearance Rate; Middle Aged; Nifedipine

Use of digitalis for the treatment of patients with congestive heart failure and sinus rhythm remains controversial. To ascertain the proper therapeutic role of digitalis, we have critically appraised the published clinical evidence of digitalis efficacy using standardized methodologic criteria. A search of the English literature from 1960 to 1982 identified 736 articles, of which 16 specifically addressed the clinical evaluation of digitalis therapy for patients with congestive heart failure and sinus rhythm. Only two double-blind, placebo-controlled trials provided clinically useful information. One study showed that digoxin therapy could be withdrawn successfully in elderly patients with stable congestive heart failure. The other showed that patients with chronic heart failure and an S3 gallop benefited from digoxin therapy.

Topics: Clinical Trials as Topic; Digitalis; Digitalis Glycosides; Digoxin; Diuretics; Drug Therapy, Combination; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Pulmonary Heart Disease; Research Design

Although digitalis glycosides were introduced for the treatment of cardiac disorders almost 200 years ago, controversy persists regarding the relative role of these inotropic agents, particularly in patients with coronary artery disease in sinus rhythm. With the advent of more potent diuretics and the demonstrated benefit of vasodilators in left ventricular unloading, the relative worth of digitalis in patients with coronary artery disease and myocardial infarction is being re-examined.

Topics: Angina Pectoris; Arrhythmias, Cardiac; Clinical Trials as Topic; Coronary Disease; Coronary Vessels; Digitalis; Heart Failure; Humans; Myocardial Infarction; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Substance Withdrawal Syndrome; Vascular Resistance

Digoxin was studied to see whether it impairs adrenal function and feminizes male subjects by changing plasma sexual hormones; both have been reported on previously. In eight healthy male subjects neither estrone (38.7 +/- 7.7 vs 35.4 +/- 3.2 pg/ml) nor estradiol (35.8 +/- 6.4 vs 32.2 +/- 3.9 pg/ml) nor testosterone (6.32 +/- 0.74 vs 6.45 +/- 0.73 ng/ml) were found to be altered by digoxin administration (plasma levels 1.55 +/0- 0.27 ng/ml) lasting 35 days. The same was true of free testosterone (147 +/- 24 vs 142 +/- 19 pg/ml) and free estradiol (657 +/- 77 vs 615 +/- 78 fg/ml). Even maximal stimulation of the adrenal and gonadal glands by adrenocorticotropic hormone (ACTH) and human chorionic gonadotropin (hCG) did not exhibit any digoxin-induced alterations in the synthesizing capacity of steroid hormones, as shown by plasma cortisol (increase from 128 +/- 18 to 389 +/- 18 ng/ml) and testosterone (from 5.96 +/- 0.90 to 10.33 +/- 1.19 ng/ml). Furthermore, seven subjects on digoxin were observed over a period of 150-210 days; they did not show any increase of estrogens. This was also found in three subjects when estrogen levels were elevated initially due to extreme obesity. Also, 35 patients who took beta-methyldigoxin (n = 8), beta-acetyldigoxin (n = 20) and digitoxin (n = 7) from 1 to 9 (mean: 1.9) years demonstrated normal plasma concentrations of gonadal and adrenal steroids, irrespective of duration of application or the digitalis compound.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenal Cortex Hormones; Adult; Digitalis; Digoxin; Gonadal Steroid Hormones; Gynecomastia; Heart Failure; Hemodynamics; Humans; Male; Plants, Medicinal; Plants, Toxic; Sex Factors

Topics: Acetyldigitoxins; Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digitoxin; Dihydroergotoxine; Drug Combinations; Drug Evaluation; Female; Heart Failure; Humans; Male; Middle Aged

The biological availability of digitoxin from Lanicor was compared with that from two different galenical preparations of Card-Lamuran (Card-Lamuran and MF708d both containing equal amounts of active ingredients: 0,125 mg digitoxin and 10 mg raubasine). The patients who were kept on their individually adjusted oral digitoxin maintenance dosage received the three preparations in a randomised order. Additionally, the equivalent dosages of Lanicor and Lanitop were determined from the data on their biological availability. In 24 patients with heart failure (mean age 70.5 years), radioimmunoassay of the glycoside concentration in the serum was performed. The patients were cardially well compensated with Lanicor and it could be assumed that there would be no change in the daily maintenance dosage for the entire period of the study (42 days). Our results show that digitoxin had the same bio-availability from Lanicor and the two different galenical preparations of Card-Lamuran and MF708d. Patients can therefore safely be switched from one of these preparations to the other. On average, doses of Lanicor 1.55 times higher than those of Lanitop must be given to obtain the same serum glycoside concentrations. The variation of this factor was no greater than the variation in serum concentrations of digitoxin during continued maintenance therapy with Lanicor. The mean serum concentrations of digitoxin under maintenance therapy in our geriatric patients (mean value 2.1 mg/ml) were higher than the digitoxin concentrations published in the literature for younger patients (average 1.4 ng/ml). The calculated daily maintenance doses providing a digitoxin concentration of 1.4 mg/ml were ca. 0.3 mg Lanicor and ca. 0.2 mg Lanitop. This is somewhat less than generally assumed. This agrees with the clinical experience that the glycoside maintenance dosage in elderly patients is generally less than in middle-aged patients.

Topics: Age Factors; Aged; Biological Availability; Biopharmaceutics; Creatinine; Digitoxin; Dosage Forms; Drug Combinations; Female; Heart Failure; Humans; Long-Term Care; Male; Methylation; Middle Aged; Radioimmunoassay; Yohimbine

Clinical open trials of beta-methyldigoxin were carried out in 15 institutions in order to examine the effect, usefulness and ease of its oral administration. In the case of oral digitalization with 0.2 mg, 3 times daily, an effect was obtained in all of 13 cases of congestive heart failure accompanied by atrial fibrillation or flutter. The average time and dose required for digitalization were about 50 hours and 1.27 mg respectively. In 9 of the 13 cases, the effect was achieved within 48 hours. The average maintenance does of beta-methyldigoxin in 102 cases of congestive heart failure with atrial fibrillation was 0.177 mg per day. About 75% of the cases were maintained with 0.15 to 0.2 mg. This range of dose of beta-methyldigoxin was much smaller than that of digoxin in our series. This can be ascribed to a higher absorption rate of beta-methyldigoxin from the digestive tract. Studies on the cases in which patients previously treated with other glycosides were switched over to beta-methyldigoxin revealed that 1 mg of beta-methyldigoxin is equivalent to 1.8 mg of digoxin or to 0.59 mg of digitoxin. The usefulness and ease of beta-methyldigoxin in maintenance was evaluated as being somewhat superior to other cardiac glycosides, according to the global judgement of the physicians. The observed side effects were similar to those of other glycosides in frequency and character.

Topics: Administration, Oral; Adult; Aged; Atrial Fibrillation; Clinical Trials as Topic; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Female; Heart Failure; Humans; Lanatosides; Male; Middle Aged; Proscillaridin

Topics: Acetyldigitoxins; Cardiac Volume; Coronary Vessels; Digitoxin; Electrocardiography; Heart Failure; Heart Function Tests; Heart Rate; Hemodynamics; Humans; Middle Aged; Radioisotope Dilution Technique

Topics: Aged; Alprenolol; Ambulatory Care; Blood Pressure; Clinical Trials as Topic; Delayed-Action Preparations; Depression, Chemical; Digitalis; Diuretics; Drug Evaluation; Drug Therapy, Combination; Female; Follow-Up Studies; Heart Failure; Heart Rate; Humans; Hydrochlorothiazide; Hypertension; Hypoglycemic Agents; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Time Factors

Topics: Aged; Alprenolol; Benzothiadiazines; Chlorthalidone; Clinical Trials as Topic; Digitalis; Diuretics; Drug Evaluation; Drug Therapy, Combination; Female; Heart Failure; Humans; Hydralazine; Hypertension; Methyldopa; Phytotherapy; Placebos; Plants, Medicinal; Plants, Toxic; Sodium Chloride Symporter Inhibitors; Time Factors

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Creatinine; Digitalis; Digoxin; Dyspnea; Edema; Female; Heart Failure; Humans; Male; Middle Aged; New York; Phytotherapy; Placebos; Plants, Medicinal; Plants, Toxic; Respiratory Insufficiency; Skilled Nursing Facilities; Time Factors

Topics: Acetates; Aged; Arrhythmias, Cardiac; Clinical Trials as Topic; Digitalis Glycosides; Digitoxin; Drug Tolerance; Electrocardiography; Female; Heart Failure; Humans; Intestinal Absorption; Male; Middle Aged; Time Factors

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Cardiac Complexes, Premature; Cardiomegaly; Clinical Trials as Topic; Coronary Disease; Digitalis Glycosides; Digitoxin; Heart Aneurysm; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Kidney Diseases; Lung Diseases; Middle Aged; Spinal Diseases; Tablets; Tachycardia

Topics: Adult; Aged; Clinical Trials as Topic; Digitoxin; Evaluation Studies as Topic; Female; Heart Failure; Humans; Male; Middle Aged

Topics: Digitoxin; Digoxin; Female; Heart Failure; Humans; Injections, Intravenous; Intestinal Absorption

Topics: Adult; Aged; Cardiac Glycosides; Clinical Trials as Topic; Digitoxin; Drug Tolerance; Female; Heart Failure; Humans; Injections, Intravenous; Lanatosides; Male; Middle Aged; Strophanthins; Tablets

Topics: Clinical Trials as Topic; Digitalis Glycosides; Digitoxin; Drug Tolerance; Heart Failure; Humans; Lanatosides

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

Topics: Adenine Nucleotides; Adenosine Triphosphate; Citrates; Digitoxin; Electrocardiography; Heart; Heart Failure; Hemodynamics; Humans; Ketoglutaric Acids; Lactates; Succinates

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

Topics: Cardiotonic Agents; Digitalis; Heart Failure; Humans; Longitudinal Studies

Topics: Aged; Digitalis; Electrocardiography; Female; Heart Conduction System; Heart Failure; Heart Rate; Humans

Topics: Cardiotonic Agents; Digitalis; Digoxin; Heart Failure; Humans; Stroke Volume

Topics: Chronic Disease; Digitoxin; Heart Failure; Humans

The effects of chronic treatment with digitoxin on arterial baroreceptor sensitivity for heart rate (HR) and renal sympathetic nerve activity (rSNA) control, cardiopulmonary reflex, and autonomic HR control in an animal model of heart failure (HF) were evaluated. Wistar rats were treated with digitoxin, which was administered in their daily feed (1 mg/kg per day) for 60 days. The following 3 experimental groups were evaluated: sham, HF, and HF treated with digitoxin (HF + DIG). We observed an increase in rSNA in the HF group (190 ± 29 pps, n = 5) compared with the sham group (98 ± 14 pps, n = 5). Digitoxin treatment prevented an increase in rSNA (98 ± 14 pps, n = 7). Therefore, arterial baroreceptor sensitivity was decreased in the HF group (-1.24 ± 0.07 bpm/mm Hg, n = 8) compared with the sham group (-2.27 ± 0.23 bpm/mm Hg, n = 6). Digitoxin did not alter arterial baroreceptor sensitivity in the HF + DIG group. Finally, the HF group showed an increased low frequency band (LFb: 23 ± 5 ms(2), n = 8) and a decreased high frequency band (HFb: 77 ± 5 ms(2), n = 8) compared with the sham group (LFb: 14 ± 3 ms(2); HFb: 86 ± 3 ms(2), n = 9); the HF+DIG group exhibited normalized parameters (LFb: 15 ± 3 ms(2); HFb: 85 ± 3 ms(2), n = 9). In conclusion, the benefits of decreasing rSNA are not directly related to improvements in peripheral cardiovascular reflexes; such occurrences are due in part to changes in the central nuclei of the brain responsible for autonomic cardiovascular control.

Topics: Animals; Autonomic Nervous System; Blood Pressure; Cardiotonic Agents; Digitoxin; Echocardiography, Doppler; Heart Failure; Heart Rate; Hemodynamics; Male; Rats; Rats, Wistar

The effects of digitalis on mortality in patients with structural heart disease are controversially discussed. We aimed to assess the effects of digitalis administration in implantable cardioverter defibrillator (ICD) recipients.. This retrospective analysis comprises 1020 consecutive patients who received an ICD at our institution and who were followed for up to 10 years (median 37 months). A total of 438 patients were receiving digitalis at the time of ICD implantation and 582 did not. Patients on digitalis were more often in atrial fibrillation and had more often a prolonged QRS duration of ≥120 ms, a severely impaired left ventricular ejection fraction, and higher New York Heart Association (NYHA) classification heart failure. Crude Kaplan-Meier analysis demonstrated significantly higher mortality in patients on digitalis (HR = 2.47; 95% CI 1.87-3.25; P = 0.001). After adjustment for patient characteristics found statistically significant in adjusted Cox regression analysis (age, gender, NYHA classification, and QRS duration of ≥120 ms), a HR of 1.65 remained (95% CI 1.14-2.39; P = 0.01). Patients on digitalis died more often from cardiac arrhythmic and cardiac non-arrhythmic causes than patients not on digitalis (P = 0.04). There was no difference in mortality between patients receiving digitoxin and those receiving digoxin (HR = 1.55; 95% CI 0.74-3.25; P = 0.25).. In this large ICD patient population, digitalis use at baseline was independently associated with increased mortality even after careful adjustment for possible confounders. Digitalis should be used with great caution in this population.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Cardiotonic Agents; Cohort Studies; Defibrillators, Implantable; Digitalis Glycosides; Digitoxin; Digoxin; Female; Follow-Up Studies; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Treatment Outcome

This is an essay dealing with the 1785 cohort study by William Withering (the "account"), in which he reported the results of the treatment with foxglove (Digitalis purpurea) in 163 patients suffering from various forms of hydropsy (water retention). Withering reported the results of all patients, and classified them into responders and non-responders. He identified the responders as suffering from heart failure. In the 18th century, medical treatments were judged as successful if they complied with the criteria a priori of the theory of the four humors, and not on the patient's response to the treatment. Withering was the first not only to compare the patient's conditions before and after treatment, but also to identify the individual clinical characteristics of the patients who responded. In modern medicine, drugs are released on the market and approved for use after what is known as "population-derived clinical research", principally randomized controlled trials, and guidelines. More than 200 years ago, Withering anticipated the current and growing trend towards individual responses to treatment, and personalized medicine.

Topics: Digitalis; Edema; Heart Failure; History, 18th Century; Humans; Precision Medicine; Treatment Outcome

Topics: Digitalis; Digitoxin; Famous Persons; Heart Failure; History, 18th Century; History, 19th Century; Humans; Medicine in the Arts; Mental Disorders; Paintings; Phytotherapy; Plant Preparations

The aim of the present study was to evaluate if the influence of digitalis on survival depends on the severity of cardiac dysfunction in heart failure (HF).. Doppler echocardiogram (DE) parameters were analyzed in 84 Wistar control (C) and 80 Wistar rats treated with 0.1mg/100g/day of digitoxin (D) five days after coronary occlusion. The DE variables correlated with the survival of the animals were: myocardial infarction size, left chamber dimensions, fractional area change and E/A ratio. The animals were observed for up to 280 days. Mortality was worsened in rats in the D group with a myocardial infarction (MI)<37% and with better DE predictors of survival. Digitoxin was found to prolong survival in rats with an MI ≥ 37% and worse DE predictors.. For the first time our study has shown experimentally that the action of digitalis glycosides can positively or negatively influence survival during treatment of HF. It prolongs survival of those in advanced state and compromises survival when there is less severity of the disease. In fact, the greater benefits occur when digitoxin was used in heightened ventricular dilatations and worse ventricular performance.

Topics: Animals; Digitalis; Digitoxin; Female; Heart Failure; Myocardial Infarction; Rats; Rats, Wistar; Severity of Illness Index; Survival Rate

Topics: Digitoxin; Heart Failure; Humans; Male; Middle Aged; Myotonic Dystrophy; Treatment Outcome

Therapeutic management in pregnant patients with heart failure still remains a challenge, even though in most pregnant women with cardiac diseases an outcome is good. A 32-year-old woman, 17 weeks pregnant, was admitted to hospital with heart failure (HF) NYHA class III/IV. Echocardiography revealed enlarged LV, LVEF 13%, significant mitral insufficiency and pulmonary hypertension. The patient wished to continue the pregnancy. In a life-threatening condition, metoprolol, enalapril, spironolactone (for 5 days), furosemide, and digitalis were administered. Enalapril was continued for 42 days. Then the patient was switched to a dihydralazine and isosorbide mononitrate regimen. The fetus was controlled ultrasonographically. In the 19th week of pregnancy, the patient's condition improved (NYHA class II, LVEF 23%). The patient experienced 2 more episodes of HF exacerbation. In the 26th week of pregnancy, in a primary prevention of sudden cardiac death and because of 2nd-degree AV block, an ICD was implanted. In the 32nd week of pregnancy a cesarean section was performed. A male infant was delivered. The patient made a good recovery and was discharged on the 7th postoperative day. The newborn was discharged after 4 weeks, in good general condition. At 1-year follow-up the patient presented NYHA class II.

Topics: Adult; Digitalis; Drug Therapy, Combination; Enalapril; Female; Furosemide; Heart Failure; Humans; Metoprolol; Pregnancy; Pregnancy Complications; Spironolactone; Ultrasonography, Doppler, Color

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiotonic Agents; Chronic Disease; Digitalis Glycosides; Digitoxin; Heart Failure; Humans; Radiography

Since William Withering's report on the foxglove in 1785, digitalis, in 1 form or another, has remained a mainstay in the treatment of congestive heart failure and as a means of rate control in atrial fibrillation. Recently, with the introduction of potent diuretics and other agents for the treatment of these conditions, there has been a deemphasis on the role of digitalis despite its therapeutic value. Continued evidence of the frequent usefulness of digitalis in both conditions suggests that this venerable drug should remain within the therapeutic armamentarium of cardiologists and other physicians.

Topics: Digitalis; Digitalis Glycosides; Heart Failure; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Phytotherapy; Plant Extracts

Topics: Digitalis; Digoxin; Heart Failure; Humans; Kidney Failure, Chronic; Renal Dialysis

Topics: Bundle-Branch Block; Cardiotonic Agents; Digitoxin; Electrocardiography; Heart Failure; Humans; Male; Middle Aged; Tachycardia, Ventricular

We analyzed whether digitoxin affects the survival of rats with congestive heart failure.. The influence of digitoxin (0.1 mg.100 g.day, orally) on the survival of infarcted female rats (n=170) randomized as Control Infarcted (CI, n=85) or Digitoxin (D, n=85) was evaluated for 280 days. Mean survival was 235+/-7 days for CI and 255+/-5 days for D (log-rank test: P=.0602). Digitoxin did not affect survival in rats with congestive heart failure from myocardial infarction <40% of the left ventricle, but did prolong survival in rats with infarction >or=40%. The log-rank test defined higher mortality (P=.0161) in CI >40% (56%) than in D >40% (34%), with a hazard ratio of 2.03. Pulmonary water content and papillary muscle mechanics were analyzed in CI (n=7) and D (n=14) survivors. Significant differences were observed regarding pulmonary water content (CI: 82+/-0.3; D: 80+/-0.3%; P=.0014), developed tension (CI: 2.7+/-0.3; D: 3.8+/-0.3g/mm(2); P=.0286) and +dT/dt (CI: 24+/-3; D: 39+/-4 mg mm(2).s; P=.0109).. In conclusion, long-term digitoxin administration reduced cardiac impairment after myocardium infarction, attenuated myocardial dysfunction, reduced pulmonary congestion, and provided the first evidence regarding the efficiency of digitoxin in prolonging survival in experimental cardiac failure.

Topics: Animals; Digitoxin; Disease Models, Animal; Female; Heart Failure; Myocardial Infarction; Rats; Rats, Wistar; Survival Rate; Treatment Outcome

Digitoxin and other cardiac glycosides are important, centuries-old drugs for treating congestive heart failure. However, the mechanism of action of these compounds is still being elucidated. Calcium is known to potentiate the toxicity of these drugs, and we have hypothesized that digitoxin might mediate calcium entry into cells. We report here that digitoxin molecules mediate calcium entry into intact cells. Multimers of digitoxin molecules also are able to form calcium channels in pure planar phospholipid bilayers. These digitoxin channels are blocked by Al(3+) and La(3+) but not by Mg(2+) or the classical l-type calcium channel blocker, nitrendipine. In bilayers, we find that the chemistry of the lipid affects the kinetics of the digitoxin channel activity, but not the cation selectivity. Antibodies against digitoxin promptly neutralize digitoxin channels in both cells and bilayers. We propose that these digitoxin calcium channels may be part of the mechanism by which digitoxin and other active cardiac glycosides, such as digoxin, exert system-wide actions at and above the therapeutic concentration range.

Topics: Antibodies; Calcium; Calcium Channel Blockers; Calcium Channels; Cell Line; Cell Membrane; Cell Survival; Digitoxin; Glycosides; Heart Failure; Humans; Kinetics; Lipid Bilayers; Phospholipids; Sensitivity and Specificity

Topics: Cardiotonic Agents; Digitoxin; Digoxin; Heart Failure; Humans; Practice Guidelines as Topic; Risk Factors

Rhabdomyolysis is a well known side effect of statin therapy. Several drugs may increase its risk by drug-drug interactions. In particular, patients with heart disease receive more and more different compounds to cope with all the pathomechanisms involved and may therefore be of high risk for side effects. We report a case of rhabdomyolysis in a patient with heart failure on a multi-drug regimen caused by a drug interaction between chronic statin therapy (simvastatin), amiodarone and newly administrated digitoxin. The patient recovered fully after cessation of simvastatin therapy, the other drugs were given continuously. Potential mechanisms of this event are discussed. Most interesting in this case is that rhabdomyolysis occurred only after starting digitoxin after long-term therapy with the statin.

Topics: Amiodarone; Anti-Arrhythmia Agents; Anticholesteremic Agents; Digitoxin; Drug Interactions; Heart Failure; Humans; Male; Middle Aged; Rhabdomyolysis; Risk Factors; Simvastatin

We aimed to investigate the status of the treatment of congestive heart failure (CHF) in academic hospitals in Turkey.. Overall 661 successive patients from 16 academic hospitals were included in this retrospective study. In addition to treatments given to the patients before admission to hospital, during their hospital stay, and at hospital discharge, data regarding their functional classifications, causes of CHF, and laboratory findings were also recorded.. In our study the mean age of patients was 61+/-12 years and the mean hospital stay 10+/-6 days. Ischemic CHF was observed more frequently in men (72% vs. 46%, p<0.001), while hypertension and rheumatic CHF were more frequent in women (27% vs. 19%, p<0.001 and 24% vs. 9%, p<0.001 respectively). While 90% of patients were in NYHA III-IV class at admission to hospital, only 2% of patients were in class IV at hospital discharge. The proportion of smokers was greater in men than in women (68% vs. 12%). Atrial fibrillation was present in 35% of patients. During hospitalization, angiotensin converting enzyme (ACE) inhibitors were used by 77%, diuretics by 95%, digitalis by 76%, nitrate by 85%, beta-blockers by 3%, aspirin by 86%, anticoagulants by 44%, Ca antagonist by 10%, positive inotropic agents by 42%; and antiarrhythmic agents by 15% of patients.. The use of ACE inhibitors, the major milestone of CHF treatment, is not on an adequate level yet. The use of beta-blockers should also be encouraged.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Anticoagulants; Aspirin; Calcium Channel Blockers; Cardiotonic Agents; Digitalis; Diuretics; Female; Heart Failure; Hospitals, Teaching; Humans; Length of Stay; Male; Medical Records; Middle Aged; Nitrates; Retrospective Studies; Severity of Illness Index; Turkey

To determine the changes of paraoxonase activity in patients with heart failure.. The serum paraoxonase (PON) activity of the heart failure group and controls was measured with phenylacetate as the substrate.. The serum PON activity of the heart failure patients significantly decreased as compared with the controls; after the treatment, the PON activity of heart failure was largely elevated; and the PON activity of the patients with heart failure was negatively correlated with tumor necrosis factor-alpha.. The PON activity of patients with congestive heart failure significantly decreases.

Topics: Adult; Aged; Aryldialkylphosphatase; Digitalis; Esterases; Female; Heart Failure; Humans; Male; Middle Aged; Tumor Necrosis Factor-alpha

Topics: Cardiac Glycosides; Cardiotonic Agents; Controlled Clinical Trials as Topic; Digitalis Glycosides; Digitoxin; Digoxin; Drug Therapy, Combination; Heart Failure; Humans; Practice Guidelines as Topic

Digitoxin is used to treat patients with heart failure.. A radioimmunoassay procedure for the specific determination for digitoxin in serum was developed using the antiserum (antiserum (A)) raised against digitoxin 3'-hemisuccinate-BSA conjugate.. The intra- and interassay variability were <10% in the range of 5-100 ng/ml. The specificities of antiserum (A) and the commercial anti-digitoxin antiserum (antiserum (B)) were assessed by cross-reactivity studies with various related compounds. Antiserum (A) was highly specific for digitoxin. Mean digitoxin concentrations in serum samples (n=34) from digitalized patients by RIA using these antisera were 10.0 and 12.4 ng/ml, respectively.. This RIA using antiserum (A) measure unmetabolized digitoxin and may be applicable for pharmacokinetic studies.

Topics: Animals; Antibodies; Antibody Specificity; Cardiotonic Agents; Cross Reactions; Digitoxigenin; Digitoxin; Heart Failure; Humans; Rabbits; Radioimmunoassay; Reproducibility of Results; Serum Albumin, Bovine

A 21-year-old woman with known endocardial fibroelastosis diagnosed when aged 3 months was admitted because of progressive dyspnoea. The physical examination revealed symptoms of heart failure, with pulmonary rales, mild hepatomegaly, and tachyarrhythmia.. The electrocardiogram showed atrial fibrillation, complete right bundle branch block and right ventricular hypertrophy. Echocardiography indicated hypertrophy and dilatation of the right ventricle (61 mm) with tricuspid regurgitation and hypoplasia of the left ventricle. Heart catheterization confirmed pulmonary hypertension (60/46 mmHg) as well as dilatation and hypokinesia of the right ventricle. Right ventricular biopsy showed severe myocardial hypertrophy resulting from secondary pulmonary hypertension, while no evidence of myocarditis or idiopathic dilated cardiomyopathy was found.. Symptoms of heart failure improved under medical treatment with digitalis, angiotensin-converting enzyme inhibitor and diuretics.. Primary endocardial fibroelastosis of the contracted type must be included in the differential diagnosis of heart failure occurring in young adults.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Cardiac Catheterization; Diagnosis, Differential; Digitalis; Diuretics; Dyspnea; Echocardiography; Electrocardiography; Endocardial Fibroelastosis; Female; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

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

Congestive heart failure (CHF) related to Sjögren's syndrome is extremely rare. This report concerns a patient who presented with CHF and severe thrombocytopenia (5,000/microl). Serum concentrations of K, Mg and digitoxin were 3.2mmol/L, 1.4mg/L and 57.2ng/ml, respectively. Digitoxin intoxication was evident, seemingly evoked by hypokalemia, hypomagnesemia, hepatorenal dysfunction and hypothyroidism. The severe thrombocytopenia was considered to have been caused by this intoxication, as it disappeared soon after the digitoxin was discontinued and potassium was supplemented.

Topics: Cardiotonic Agents; Digitoxin; Female; Heart Failure; Humans; Middle Aged; Sjogren's Syndrome; Thrombocytopenia

To evaluate whether or not beta-blockers can improve the condition of patients with heart failure treated with a combination of diuretics, digitalis and angiotensin-converting enzyme inhibitor (ACEI), 52 patients with chronic heart failure who have been treated with ACEI for more than 6 months were enrolled. They were divided into 2 groups: 26 patients continued the same therapy another 6 months or more (group A), and 26 patients were given oral metoprolol for 6 months or more, in addition to the ACEI (group B). Echocardiographic parameters and atrial and brain natriuretic peptides (ANP, BNP) were measured. The left ventricular dimensions at end-diastole and end-systole were significantly decreased and fractional shortening was significantly increased in group B after 6 months' treatment with the beta-blocker, but these parameters remained unchanged in group A. Plasma levels of both ANP and BNP were significantly decreased in group B, but remained unchanged in group A. These results indicate that concomitant beta-blocker therapy can improve left ventricular function and attenuate plasma ANP and BNP levels in patients with chronic heart failure treated with ACEI.

Topics: Adrenergic beta-Antagonists; Adult; Angiotensin-Converting Enzyme Inhibitors; Atrial Natriuretic Factor; Digitalis; Diuretics; Echocardiography; Female; Heart Failure; Hemodynamics; Humans; Male; Metoprolol; Middle Aged; Natriuretic Peptide, Brain; Phytotherapy; Plants, Medicinal; Plants, Toxic; Ventricular Function, Left

A 50-year-old man received an orthotopic heart transplant because of severe coronary heart disease and congestive heart failure. Two years after the transplantation, a continuous murmur occurred at the left sternal edge after repeated endomyocardial biopsies. Echocardiography and coronary angiography revealed a dilated left anterior descending artery with a fistula to the right ventricle. The circumflex was large with an equally postero-lateral branch, and the right coronary artery was rather small with collaterals to the distal part of the left anterior descending branch. The patient had refused any intervention to close the fistula. The left ventricular levogram was normal. Two years later, in a follow-up angiogram, the left ventricular ejection fraction had decreased as a result of hypo- and akinesis of the apex and posterior wall. We suggest that this local wall motion disturbance derives from a steal phenomenon rather than being a sequela of rejection. The decrease in left ventricular ejection fraction was associated with shortness of breath upon moderate exercise. Standard heart failure medication relieved the patient's symptoms. The observation of local wall motion disturbances in this case, as well as conflicting views in the literature, raises the question whether postbiopsy coronary fistulas in transplant patients should be closed.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiac Catheterization; Coronary Angiography; Coronary Disease; Digitalis; Echocardiography; Follow-Up Studies; Heart Failure; Heart Transplantation; Heart Ventricles; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Postoperative Complications; Vascular Fistula; Ventricular Dysfunction, Left; Ventricular Function, Right

Digitoxin is frequently used in Norway in the treatment of cardiac failure. Digitalis glycosides may give rise to a number of side effects difficult to separate from disease in the elderly. Six patients aged 77-93 years, treated with digitoxin 0.05 mg/day, were hospitalized due to digitalis intoxication. Mean digitoxin half-life was 25.2 days. This is significantly more than reported in other studies on younger patients. The symptoms of digitoxin intoxication disappeared on discontinuation of medication. The slow elimination of digitoxin may be related to reduced serum albumin concentration. When digitoxin is used in the treatment of heart failure in the very elderly patients, one should be aware of the possibility of digitoxin intoxication, even at a low dose.

Topics: Aged; Anti-Arrhythmia Agents; Cardiotonic Agents; Digitoxin; Half-Life; Heart Failure; Humans

Topics: Cardiotonic Agents; Digitoxin; Digoxin; Drug Administration Schedule; Drug Overdose; Heart Failure; Humans; Risk Factors; Tachycardia, Supraventricular

Heart failure is a common and increasing public problem. Neurohormonal activation plays a role in the pathophysiology of heart failure, but is probably also affected by cytokines. We studied 75 patients with heart failure NYHA functional class II and III-IV, who were treated with angiotensin converting enzyme inhibitor (enarenal), diuretics (furosemide) and digoxine. Their mean age was 63.9 years/range 65-86/, left ventricular ejection fraction in the patients NYHA functional class II and III-IV classes was 68.9% and 47.3% respectively; 12 were females. Significant improvements in NYHA classification were shown. The levels plasma TNF-alpha (tumor necrosis factor-alpha) and interleukin-6 (IL-6) were analysed before and after therapy. The authors showed increased plasma levels TNF-alpha and IL-6 in patients with chronic heart failure. After the treatment the plasma IL-6 levels decreased only in the patients III-IV NYHA functional classes, whereas the treatment had no effect on the plasma TNF-alpha levels.

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Digitalis; Diuretics; Female; Heart Failure; Humans; Interleukin-6; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Treatment Outcome; Tumor Necrosis Factor-alpha

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Clinical Trials as Topic; Digitalis; Diuretics; Evidence-Based Medicine; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Prognosis

Topics: Administration, Oral; Aged; Aged, 80 and over; Arnica; Carbonates; Digitalis; Drug Combinations; Heart Failure; Hemodynamics; Homeopathy; Humans; Middle Aged; Myocardial Ischemia; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Rosales; Treatment Outcome

The digitoxin half-life in elderly patients in the eight and ninth decade was more prolonged (mean +/- SD: 25 +/- 9 days) than in younger people (6.7 +/- 1.7). These elderly patients accumulated digitoxin even on a dose of 0.05 mg/ day. The symptoms of digitoxin intoxication disappeared on discontinuation of medication. When digitoxin is used in the treatment for heart failure in the very elderly patients, one should be aware of the possibility of digitoxin intoxication, even on a low dose.

Topics: Aged, 80 and over; Aging; Cardiotonic Agents; Digitoxin; Heart Failure; Humans

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

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiotonic Agents; Digitalis; Diuretics; Heart Failure; Humans; Phosphodiesterase Inhibitors; Plants, Medicinal; Plants, Toxic; Pyrazines; Quinolines; Vasodilator Agents

Topics: Animals; Anti-Arrhythmia Agents; Cardiotonic Agents; Digitoxin; Drugs, Chinese Herbal; Heart Failure; Humans

To evaluate if enalapril treatment can influence skeletal muscle metabolism and histology we investigated 26 patients with congestive heart failure and 20 normal subjects. The patients were treated with enalapril for 3 months in addition to diuretics and digitalis. Biopsies from the lateral vastus muscle were taken before and after treatment. Citrate synthetase, 3-hydroxyacyl-CoA dehydrogenase and phosphorylase activities were significantly decreased in the patients compared with controls. The number of capillaries per fibre and the number of capillaries surrounding each fibre were significantly decreased among patients. After 3 months of enalapril treatment functional class improved significantly. The lactate dehydrogenase activity increased whereas the oxidative enzymes did not change significantly. The type I, II and II A fibre areas increased significantly after enalapril treatment. We conclude that patients with chronic heart failure have decreased activity of oxidative enzymes and of phosphorylase in skeletal muscle. They also have decreased capillarization in skeletal muscle. These changes were not influenced by enalapril treatment. The increase in muscle fibre area seen after enalapril treatment could be due to increased physical activity. The cause of increased muscle lactate dehydrogenase activity after enalapril treatment needs further investigation.

Topics: 3-Hydroxyacyl CoA Dehydrogenases; Aged; Biopsy; Capillaries; Citrate (si)-Synthase; Digitalis; Diuretics; Enalapril; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Muscle, Skeletal; Phosphorylases; Plants, Medicinal; Plants, Toxic

Topics: Adult; Aged; Child; Digitoxin; Digoxin; Drug Interactions; Heart Failure; Humans; Tachycardia, Supraventricular

A 65-year-old woman, known to have peptic ulcers, developed nausea and retching. Clinical examination demonstrated pain on pressure in the epigastrium with otherwise normative findings for age. Two gastric ulcers and gastritis with erosions were seen at endoscopy. The patient, who was being treated with digitoxin for heart failure, reported having taken up to four digitoxin tablets (0.07 mg each) daily because she had insomnia. The plasma digitoxin level was between 150 and 160 nmol/l (therapeutic range 17-33 nmol/l), while the ECG showed no signs of digitalis intoxication. Initially the platelet count was 40,000/microliter: there had been no history of thrombocytopenia or symptoms of abnormal haemostasis. Other laboratory tests were within normal limits. After digitoxin had been discontinued, the platelet count rose without further treatment to 373,000/microliter 3 weeks after hospital admission by which time the digitoxin level had fallen to 48.9 nmol/l. The gastrointestinal symptoms regressed completely on treatment with omeprazole (40 mg three times daily for 8 days) and ranitidine (150 mg twice daily).

Topics: Aged; Digitoxin; Drug Overdose; Female; Gastritis; Gastroscopy; Heart Failure; Humans; Nausea; Omeprazole; Platelet Count; Ranitidine; Stomach Ulcer; Thrombocytopenia; Vomiting

Topics: Adult; Age Factors; Aged; Anti-Arrhythmia Agents; Cardiotonic Agents; Counterpulsation; Critical Care; Digitalis; Diuretics; Heart Failure; Heart Transplantation; Humans; Monitoring, Physiologic; Nutritional Physiological Phenomena; Oxygen Inhalation Therapy; Physical Therapy Modalities; Plants, Medicinal; Plants, Toxic; Prognosis; Respiration, Artificial; Ultrafiltration; Vasodilator Agents

Topics: Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Diet, Sodium-Restricted; Digitalis; Diuretics; Exercise; Heart Failure; Hospitalization; Humans; Plants, Medicinal; Plants, Toxic

A 82-year-old woman was admitted to hospital because of heart failure, vomiting, and pain in the right upper abdomen. During the past three months she had received treatment with 0.07 mg digitoxin twice daily. The ECG showed sinus bradycardia with intermittent complete sinoatrial block. On the basis of the history, clinical presentation and ECG findings digitalis intoxication was suspected. Digitoxin level was 65.23 ng/ml--far beyond the therapeutic range. Laboratory examinations revealed a marked thrombocytopenia (25,000/microliters). The patient was placed on cholestyramine (4g three times daily) to accelerate intestinal excretion of digitoxin. As there were no life-threatening complications there was no indication for treatment with digitalis-specific antibodies. On the 6th day after discontinuation of digitoxin treatment the platelet count showed a marked rise and returned to normal values as from the 12th day.

Topics: Aged; Aged, 80 and over; Bradycardia; Digitoxin; Electrocardiography; Female; Heart Block; Heart Failure; Humans; Thrombocytopenia

Topics: Aged; Amyloidosis; Biopsy; Captopril; Cardiomyopathy, Restrictive; Diagnosis, Differential; Digitoxin; Drug Therapy, Combination; Echocardiography; Echocardiography, Doppler; Female; Furosemide; Heart Failure; Hemodynamics; Humans; Intestinal Mucosa; Myocardium; Rectum

Topics: Aged; Aged, 80 and over; Aging; Cardiac Output; Coronary Vessels; Digitalis; Diuretics; Heart Failure; Heart Valves; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Recurrence; Vasodilator Agents; Ventricular Function, Left

Long-term beta-blocker therapy may be useful in some patients affected by chronic heart failure. In a group of 15 patients with chronic heart failure of different origin we evaluated clinical, hemodynamic and neurohormonal features after 1 year of therapy. All patients were treated with atenolol at dosage of 50 mg/die. We observed a better ejection fraction by radionuclide angiography after 1 year of treatment. There was an increase of exercise time and VO2 max evaluated by cycloergometer test. There was a decrease of mean pulmonary artery pressure, of pulmonary vascular resistance and of right atrial pressure. Plasmatic norepinephrine decreased from 1294 +/- 568 to 574 +/- 33 pg/l. Our results suggest that patients who well tolerated chronic beta-blockade show an improvement of performance parameters.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Atenolol; Chronic Disease; Digitalis; Diuretics; Drug Evaluation; Drug Therapy, Combination; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Neurotransmitter Agents; Plants, Medicinal; Plants, Toxic

Topics: Adult; Aged; Atrial Natriuretic Factor; Cross Reactions; Digitalis; Diuretics; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Plants, Medicinal; Plants, Toxic; Radioimmunoassay

Topics: Arrhythmias, Cardiac; Cardiac Glycosides; Catecholamines; Chronic Disease; Digitalis; Heart Failure; Humans; Physical Endurance; Plants, Medicinal; Plants, Toxic; Prognosis; Vasodilator Agents; Ventricular Function, Left

Topics: Digitalis; Drug Therapy, Combination; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic; Stimulation, Chemical; Vasodilator Agents

Withering's (1741-1799) greatest merit is not so much that of having discovered the therapeutic value of foxglove in hydropsy, since this indication (among others) was already part of traditional medicine, but actually during a decade of carefully recording clinical observations, he authoritatively settled definite guidelines for its use. In spite of its further utilization in many additional illnesses such as madness, foxglove, and later its main heteroside digitoxine, progressively reached their eventual place in the treatment of supraventricular arrhythmias and in congestive heart failure. In the latter indication, however, its value is now being questioned; it is being accused of augmenting myocardial work due to its vasoconstrictor properties, of favoring dysrhythmic events in a disease already burdened with a 50% arrhythmia mortality, and actually of having a low therapeutic index. Even though being discarded by a number of cardiologists, digitoxine still remains in the appraisal of others as an indispensable medicine.

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart Failure; History, 18th Century; History, 19th Century; Plants, Medicinal; Plants, Toxic

Clinical and hemodynamic studies were carried out in 20 patients suffering from refractory congestive heart failure with invasive technique and non-invasive methods such as tolerance exercise test, 24-hour Holter monitoring, etc. Digitalis was then withdrawn and China-made amrinone (AMR) was administered orally for 15 days. All the indices mentioned above were repeated and each patient served as his own control. The results indicate that AMR can improve hemodynamic parameters as well as exercise tolerance. Holter monitoring revealed no significant increase in arrythmogenic potentiality. The total clinical effective rate was 95%. No severe side effects were found except thrombocytopenia observed in 20% of the patients. It is suggested that China-made AMR is effective in treating refractory congestive heart failure.

Topics: Adult; Amrinone; Digitalis; Electrocardiography, Ambulatory; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic

Between 1986 and 1988 within our therapeutic drug monitoring plasma concentrations were estimated in 1,442 plasma samples by radioimmunoassay. Plasma levels between 0 and 84.2 ng.ml-1 with a mean of 20.8 ng.ml-1 were measured. If the maintenance dose was reduced from 0.1 to 0.07 mg the frequency distribution of the plasma samples was shifted to the left, and the mean value decreased by 5.8 ng.ml-1 (23.5 vs. 17.7 ng.ml-1). The physician's assumptions underdosage?, optimum dosage schedule? or overdosage? were confirmed by the laboratory results in 22.3, 63.6, or 23.0% of the requests, respectively. In 61.2% of all plasma samples were digitoxin concentrations in the range between 10 and 30 ng.ml-1, i.e. in the optimum therapeutic range. Main reasons for the divergent results are non-compliance of the patients and inter-individual differences in the pharmacokinetics of digitoxin. Furthermore, incomplete filling of the forms by the physicians aggravates the assessment of the results. Therefore, a permanent dialogue between clinician and clinical pharmacologist is necessary for an improvement of digitalis therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Child; Child, Preschool; Digitoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Infant; Middle Aged; Radioimmunoassay

32 dogs with congestive heart failure without sufficient reaction to a standardized therapy with glycosides are treated with an individual glycoside dose. The therapy is controlled by the serum concentration of the cardiac glycoside. The influence of additional diseases and medications is demonstrated. Finally a rule for the evaluation of the therapeutic glycoside dose is given.

Topics: Animals; Cardiac Glycosides; Digitoxin; Digoxin; Dog Diseases; Dogs; Heart Failure

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

Although the effects of epinephrine and norepinephrine in congestive heart failure have been extensively studied, and exogenous dopamine, another of the catecholamines, has been widely used for the treatment of congestive heart failure, little attention has been paid to the physiological significance of endogenous dopamine in this condition. The present study was therefore designed to assess the physiological significance of endogenous dopamine in congestive heart failure. Nineteen patients with congestive heart failure caused by such conditions as acute myocardial infarction, valvular disease and dilated cardiomyopathy were examined before and after treatment with diuretics, digitalis and vasodilators. Electrolyte, creatinine and catecholamine concentrations in plasma and urine were analyzed. Urinary dopamine levels were increased in 13 out of 19 cases before treatment and returned to the normal range after treatment, falling from 2448 +/- 950.7 to 528.8 +/- 56.3 micrograms/day (normal level, less than 700 micrograms/day). Urinary dopamine excretion was markedly elevated within 24 hours after the onset of symptoms of heart failure, such as chest pain, palpitations and dyspnea. The relationship between urinary dopamine excretion and time after the onset of symptoms showed a strong statistical correlation (r = 0.55, p less than 0.001). Urinary dopamine excretion was also well correlated with plasma dopamine concentration, urinary norepinephrine excretion and venous pressure. From these results, it is concluded that endogenous dopamine seems to play an important role during the acute phase of congestive heart failure.

Topics: Adult; Aged; Aged, 80 and over; Digitalis; Diuretics; Dopamine; Female; Heart Failure; Humans; Male; Middle Aged; Norepinephrine; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Digoxin; Heart Failure; Humans; Hydralazine; Plants, Medicinal; Plants, Toxic

Color discrimination ability of 100 in-patients suffering from congestive heart failure and treated with digitoxin (D), pengitoxin (P), or digoxin (Dg) was determined with the Farnsworth-Munsell 100 Hue test (FM 100) and compared with the color discrimination of 72 in-patients who were not treated with digitalis glycosides (control group C). Parallel to the performance of the FM 100, the glycoside plasma level was measured by radioimmunoassay. The total error score (TES) of the FM 100 was correlated with the glycoside plasma level and the patient's age. In the C as well as in the D or P groups up to 172 errors and in the Dg group up to 586 errors were observed. With the exception of Dg, no differences were observed between the regression lines indicating an age-dependent increase in TES even under D or P treatment. In contrast to the two glycosides, Dg enhances the TES in therapeutically relevant plasma concentrations. The differences between the glycosides are due to differences in their volume of distribution and their plasma protein binding.

Topics: Acetyldigoxins; Adolescent; Adult; Aged; Aged, 80 and over; Color Perception; Digitoxin; Digoxin; Discrimination, Psychological; Female; Heart Failure; Humans; Male; Middle Aged

Eight patients in sinus rhythm with chronic heart failure were studied. After individually adjusted six-week treatment with diuretics (hydrochlorothiazide-triamtere and/or frusemide) all patients were clearly improved symptomatically. Subsequently they additionally received digitoxin for six weeks, 0.07-0.1 mg daily. Before and at the end of the digitoxin period cardiac volume was determined radiologically, echocardiography was performed and haemodynamic parameters determined at rest and on exercise via indwelling catheters. During digitoxin administration there was a slight increase in cardiac output from 4.63 +/- 0.82 to 5.05 +/- 0.98 l/min (P less than 0.1) at rest and from 7.22 +/- 1.94 to 7.79 +/- 2.59 l/min at rest. The mean values of all other haemodynamic parameters remained unchanged. These results suggest that in patients with chronic heart failure and sinus rhythm any clinical or haemodynamic improvement achieved will not be significantly bettered by digitoxin.

Topics: Adult; Aged; Digitoxin; Diuretics; Drug Evaluation; Drug Therapy, Combination; Echocardiography; Female; Furosemide; Heart Failure; Hemodynamics; Humans; Hydrochlorothiazide; Male; Middle Aged; Prospective Studies; Time Factors; Triamterene

Topics: Digitalis; Digoxin; Diuresis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Chronic effects of captopril were studied in 29 patients (age, 4 months to 16 years; mean, 6.9 years) suffering from digitalis and diuretic resistant congestive heart failure (CHF) or hypertension of different etiology. Twenty two patients with CHF (13 dilated, 4 restrictive cardiomyopathy, 5 congenital heart defects) and 7 cases with hypertension were treated for 1 to 31 months (mean, 9 months). The dose of captopril varied from 1 to 3 mg/kg/day (mean, 2.2 mg) in CHF and from 1.1 to 6.8 mg/kg/day (mean, 3.7 mg) in hypertension. In CHF digoxin therapy was maintained while the dose of diuretics could be reduced or discontinued. In 4 severely hypertensive patients the addition of a diuretic or beta blockers was necessary. In CHF clinical improvement was observed in 13 patients (59%), while there was no response in 4 and 5 patients died. The survivors exhibited a significant decrease of the cardiothoracic index (p less than 0.05), the PEP/LVET ratio (p less than 0.05) and an increase of the echocardiographic linear ejection fraction (p less than 0.001). If hypertension was present, blood pressure decreased in all patients (p less than 0.05). Captopril was well tolerated by all patients except one who developed anaemia. This side effect disappeared after having discontinued the drug. These findings suggest that captopril is of benefit in controlling chronic CHF. Captopril alone or in combination with other drugs is effective in the management of severe hypertension.

Topics: Adolescent; Captopril; Cardiomyopathy, Dilated; Cardiomyopathy, Restrictive; Child; Child, Preschool; Digitalis; Diuretics; Drug Resistance; Heart Failure; Humans; Hypertension; Hypertension, Renovascular; Infant; Male; Plants, Medicinal; Plants, Toxic; Stroke Volume

Topics: Digitalis; Heart Failure; History of Medicine; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Plants, Medicinal; Plants, Toxic

Topics: Digitoxin; Heart Failure; Humans; Tachycardia

In 1063 patients (greater than or equal to 60 years, 531 men, 532 women) the plasma concentration during digitalis maintenance therapy (metildigoxin, n = 356, beta-acetyldigoxin, n = 359, and digitoxin, n = 348) was determined and related to sex, age, body weight, serum potassium, renal function and the prescribed daily maintenance dose. Classification of treatment groups according to renal function (Crea less than or equal to 1.3 mg/dl parallel greater than 1.3 mg/dl) did not show any difference of the mean maintenance doses. In multiple linear regression analyses only a weak relationship between plasma digitalis concentration and the studied variables was found, which could be equally attributed to dose, creatinine and serum potassium in the digoxin derivative groups, whereas for digitoxin only body weight had a significant effect on the plasma concentration. During a maintenance dose of 0.07 or 0.1 mg/die which was given to 87% of patients in the digitoxin group, 70% were found to have plasma levels within the therapeutic range.

Topics: Acetyldigoxins; Aged; Body Weight; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Kidney Function Tests; Medigoxin

Topics: Adrenergic beta-Antagonists; Cardiovascular Diseases; Coronary Disease; Digitalis; Diuretics; Drug Therapy, Combination; Heart Failure; Humans; Hypertension; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Prognosis; Vasodilator Agents

Advances in our understanding of the pathophysiology of cardiac-ventricular failure and the pharmacophysiology of adrenergic receptors have greatly improved the short-term therapy of the low-output, hypotensive-hypoperfused, cardiac failure states. Agents are now specifically selected for these conditions on the basis of their predominant effects on the heart (positive inotropy) and the peripheral vasculature (vasodilatation or vasoconstriction). With the addition of dobutamine therapy, the pharmacophysiologic spectrum now includes norepinephrine (predominant vasopressor), dopamine (combined vasopressor-positive inotrope), dobutamine (predominant positive inotrope), and isoproterenol (combined positive inotrope-vasodilator). Digitalis was introduced to the medical profession 200 years ago. In terms of chronically administered positive inotropic therapy, to date, this "old-timer" has not been replaced. The yet experimental phosphodiesterase inhibitors, enoximone and milrinone, appear promising as long-term nonparenteral inotropes; however, the precise role, clinical effectiveness, and safety profile of these agents remain to be determined.

Topics: Amrinone; Blood Pressure; Cardiotonic Agents; Digitoxin; Dobutamine; Dopamine; Enoximone; Heart Failure; Hemodynamics; Humans; Imidazoles; Isoproterenol; Milrinone; Norepinephrine; Phosphodiesterase Inhibitors; Pyridones; Stroke Volume; Time Factors

Topics: Child; Child, Preschool; Digitoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Infant; Infant, Newborn

Topics: Age Factors; Aged; Arrhythmia, Sinus; Digitoxin; Heart Failure; Humans; Middle Aged

Topics: Cardiomegaly; Digitalis; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic

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

Topics: Atrial Fibrillation; Digitalis; Heart Failure; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Plants, Medicinal; Plants, Toxic; United Kingdom

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Heart Failure; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Catecholamines; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents; Xanthines

Topics: Aged; Digitalis; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Chronic congestive heart failure is a frequently occurring disease associated with an impaired quality of life and significant mortality rate. Progress has been made in dissecting the pathophysiologic changes of congestive failure and in using vasodilators, newer positive inotropic agents, and other treatment modalities. Despite these advances, the overall mortality rate from congestive heart failure has not decreased. Further, many unanswered questions remain: How and why does a myocardial cell die? How should quality of life be measured? When should vasodilators and positive inotropic agents be given? What role do receptors play in pathogenesis and therapy? Can sudden death in heart failure be prevented? These and other questions will provide the stimulus for further studies in congestive heart failure.

Topics: Aminopyridines; Amrinone; Biopsy; Calcium Channel Blockers; Cardiology; Chronic Disease; Digitalis; Dobutamine; Dopamine; Forecasting; Heart Failure; Hemodynamics; Humans; Infusions, Parenteral; Myocardial Contraction; Myocardium; Plants, Medicinal; Plants, Toxic; Prognosis; Quality of Life; Vasodilator Agents

The aim of the present study was to investigate muzolimine pharmacokinetics and pharmacodynamics in chronic heart failure. We report preliminary results from 6 patients, aged 64.2 years (range 54-73), in chronic heart failure (NYHA class III). All patients had lowered ejection fraction determined by echocardiography, and increased heart volume determined by cardiac X-ray. They were under treatment with long-term digitoxin with serum digitoxin concentrations within or below the therapeutic range. We investigated muzolimine pharmacokinetics on day 1 of treatment and after 28 days. Heart rate and rhythm were monitored with 24 hours ECG recording and analyzed on an Avionics Arrhythmia Analyzer. Heart rate, cardiac volume, ejection fraction and laboratory findings were not significantly changed between day 1 and day 28 of treatment. The time for peak absorption ranged between 1.5 and 6 hours on day 1 and 1.0 and 3 hours on day 28. The peak concentration was significantly higher on day 28. No significant difference was found in the areas under the concentration curves, serum elimination half-lives and renal clearances after acute and chronic administration. In the first 4 patients studied, we found ventricular and supraventricular arrhythmias before treatment and after 28 days on muzolimine. These preliminary data indicate a change in the pharmacokinetics of muzolimine on chronic dosing with more rapid absorption, higher peak concentrations, and increased area under the other plasma concentration curves.

Topics: Aged; Digitoxin; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Kinetics; Male; Middle Aged; Muzolimine; Pyrazoles; Time Factors

The effect of diltiazem (D) on the pharmacokinetics and pharmacodynamics of beta-acetyldigoxin (AD; n = 12) and digitoxin (DGT; n = 10) was studied in 22 patients with cardiac insufficiency stages II-III by the New York Heart Association. Glycoside plasma concentration and renal excretion as well as electrocardiogram [heart rate, atrioventricular transconduction time (PQ), duration of electrical systole corrected for heart rate (QTc), mean amplitude of T-waves in leads V2 to V6 (TV2-6)] and systole time intervals [total electromechanical systole index (QS21), left ventricular ejection time index (LVETI), pre-ejection period index (PEPI), PEP/LVET ratio] were recorded repeatedly before and during co-administration of 180 mg/day D. In eight patients digoxin plasma levels increased continuously during additional D administration. After reaching a new steady state at 0.93 +/- 0.35 ng/ml digoxin concentrations were at an average 43% higher than before D administration (0.65 +/- 0.27 ng/ml) with a simultaneous increase in renal glycoside excretion. The other four patients showed neither changes in digoxin concentrations in plasma nor in renal glycoside excretion. Only half the patients treated with DGT and D revealed an increase in DGT plasma levels of 21.4%. Daily renal glycoside excretion was not altered by D administration. In accordance to the increasing AD plasma concentration, PQ-interval was prolonged and T-wave flattening was intensified, whereas the systolic time intervals after concomitant treatment of AD and D did not differ from those after AD alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acetyldigoxins; Aged; Benzazepines; Blood Pressure; Digitoxin; Digoxin; Diltiazem; Drug Therapy, Combination; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Pulse

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Drug Interactions; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Topics: Age Factors; Aged; Antihypertensive Agents; Blood Pressure; Digitoxin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Heart Failure; Humans; Hypertension

The effect of therapeutic doses of digitalis in modifying neural activity has been the subject of considerable controversy. In earlier studies we reported an increase both in serotonergic activity in the posterior hypothalamus and pons-medulla and in cardiac sympathetic tone in the failing cardiomyopathic hamster. In this study we examine the effects of doses of digitoxin, known to be therapeutic for hamster heart failure, on monoamine neurotransmitter metabolism in the brain and heart during the cardiomyopathy. Both digitoxin and ASI-222, a polar amino-glycoside which does not cross the blood-brain barrier, given either acutely (6 mg/kg ip) or chronically (2 mg/kg/day ip for 10 days), normalized the failure-induced increase in serotonin turnover in the pons-medulla but had no effect on the changes in the posterior hypothalamus. Digitoxin therapy also reduced cardiac and adrenal sympathetic activity partially restoring cardiac catecholamine stores. In order to more clearly define the pathways involved we measured serotonin (microgram/g protein) in 18 brain nuclei after 10 days of digitoxin or vehicle treatment. Heart failure was associated with an increase in serotonin in five nuclei: the mammillary; bodies, ventromedial, periventricular and paraventricular nuclei of the hypothalamus, and the centralis superior nucleus of the raphe. Digitoxin therapy completely normalized the changes in the centralis superior and ventromedialis nuclei; neither congestive heart failure nor digitoxin affected serotonin levels in other nuclei. We conclude that there is an increase in activity in specific brain serotonergic nuclei in congestive heart failure. Digitalis reduces cardiac sympathetic tone and restores the changes in two of these nuclei: the ventromedial and the centralis superior.+2

Topics: Animals; Autonomic Nervous System; Brain; Catecholamines; Cricetinae; Digitoxin; Heart; Heart Failure; Male; Myocardium; Serotonin; Tissue Distribution; Ventromedial Hypothalamic Nucleus

Topics: Arrhythmia, Sinus; Digitalis; Digitalis Glycosides; England; Heart Failure; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Ion Channels; Plants, Medicinal; Plants, Toxic; Sodium

Topics: Adult; Aged; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic

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

Topics: Animals; Digitalis; Digitalis Glycosides; Heart Failure; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Plants, Medicinal; Plants, Toxic; United Kingdom

To determine whether treatment with digitalis is associated with decreased survival after acute myocardial infarction (AMI), data from 504 patients who were enrolled in a postinfarction natural history study were analyzed. At the time of discharge, 229 patients (45%) were taking digitalis. After 3 years of follow-up, the cumulative survival rate for patients discharged on a regimen of digitalis was 66%, compared with 87% for those not treated (p less than 0.001). Univariate analysis showed that statistically significant differences existed between the 2 groups with respect to age, previous AMI, left ventricular failure in the coronary care unit, atrial fibrillation in the coronary care unit, peak creatine kinase levels, enlarged heart and pulmonary vascular congestion on the discharge chest x-ray, ventricular arrhythmias and treatment with diuretic, antiarrhythmic and beta-blocking drugs. Survival analysis using Cox's regression model showed that the association between digitalis and decreased survival was of borderline significance after adjustment for atrial fibrillation and left ventricular failure. Serum digoxin concentration was measured in 83% of the patients who took digitalis. Survival was inversely and significantly related to serum digoxin, i.e., the higher the serum digoxin concentration, the lower the long-term survival rate. After adjusting for atrial fibrillation and left ventricular failure, serum digoxin was not significantly related to survival. Taken together with the results of 3 other large, nonrandomized studies of digitalis treatment after AMI, this study suggests that digitalis treatment may have adverse effects on survival during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Fibrillation; Digitalis; Digoxin; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Risk

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

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Kinetics; Myocardial Contraction; Sodium-Potassium-Exchanging ATPase; Uremia

Two noninvasive methods for diagnosing cardiac function, the determination of systolic time intervals (STI) and radiocardiography-cyclography (RCG), were investigated in parallel on two study groups - patients with healthy heart and patients with myocardial insufficiency - before and after glycoside treatment with regard to their diagnostic validity by inter- and intraindividual comparison. The STI in patients with myocardial insufficiency clearly deviated from the values found in normals, but reached, however, the limit of significance only for the equalized pre-ejection period (PEP) and the quotient according to Weissler (PEP/LVET). A reliable quantitative conclusion about cardiac function by interindividual comparison with the help of STI, therefore, does not seem possible. The intraindividual comparison (before and during glycoside treatment) reveals statistically significant alterations in STI. In patients with myocardial insufficiency, the radiocardiographic findings in part exhibit considerable deviations from the expected values and those of other authors. Methodological and pathophysiological causes of these deviations are discussed. Taking into consideration methodological factors of influence (body position etc.), RCG yields quantitatively significant conclusions about the functional condition of the normal and insufficient heart and is, therefore, in its diagnostic valency superior to the determination of STI.

Topics: Aged; Coronary Disease; Digitoxin; Electrocardiography; Female; Heart Failure; Hemodynamics; Humans; Indium; Male; Middle Aged; Radioisotope Dilution Technique; Radioisotopes

Kidney independent glycosides offer a high measure of therapeutic safety in comparison with kidney dependent glycosides. The intoxication rate lies between 4 and 6%. The pharmacokinetic properties of pentaformylgitoxin (INN: gitoformate) are comparable with those for digitoxin. The active glycoside 16-formylgitoxin (INN: gitaloxin) is formed by rapid deformylation of the formyl residue on the sugar chain. The maintenance dose of 0.06 mg daily, based on the half-life, produces therapeutic concentrations in the range 6-30 ng/ml. The required loading dose, as for digitoxin, amounts to 10 times the maintenance dose.

Topics: Cardiac Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Hypokalemia; Kidney; Protein Binding; Risk; Serum Albumin

In ten patients in heart failure for which they were on long-term administration of digitoxin, the influence of aluminium-magnesium hydroxide gel (Maaloxan) on steady-state digitoxin plasma concentration and renal glycoside excretion was studied. Compared with control values before antacid medication (13.6 +/- 4.4 ng/ml), the administration of 20 ml aluminium-magnesium hydroxide gel three or four times daily for several weeks caused no significant change in digitoxin plasma levels (15.1 +/- 4.9 ng/ml). Daily renal glycoside excretion, as a further measure of bioavailability of digitoxin, was also unchanged by the antacid. Therapeutic plasma concentrations of digitoxin are not influenced by antacids which contain aluminium-magnesium hydroxide, at least not if the antacid is taken 1-2 hours after the digitoxin dose.

Topics: Aged; Aluminum Hydroxide; Digitoxin; Drug Combinations; Drug Interactions; Female; Glycosides; Heart Failure; Humans; Kidney; Magnesium; Magnesium Hydroxide; Male; Middle Aged; Time Factors

Topics: Animals; Digitalis; Dogs; Electrolytes; Erythrocytes; Heart Failure; Humans; Magnesium; Plants, Medicinal; Plants, Toxic

Topics: Cardiotonic Agents; Digitalis; Diuretics; Heart; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

Topics: Arrhythmias, Cardiac; Digitalis; Heart Failure; Humans; Magnesium; Plants, Medicinal; Plants, Toxic

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

Topics: Adult; Aged; Digitalis; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Kinetics; Male; Myocardial Contraction; Plants, Medicinal; Plants, Toxic

As a result of overdosage a 77-year-old patient with heart disease developed digitoxin intoxication, associated with arrhythmias, extracardiac symptoms of intoxication and severe thrombocytopenia. Treatment with digoxin-specific antibody fragments relieved the signs and symptoms of intoxication within a few hours. The rise in platelet count from the pretreatment value of 26 000/mm3 to 47 000 within 12 h and to over 60 000/mm3 within 16 h of starting the antibody infusion may also be attributed to the treatment with antibodies. Such a rapid recovery from digitoxin-induced thrombocytopenia has not hitherto been described. Digoxin-specific antibodies, obtained by immunization of sheep with a digoxin-albumin conjugate, were used to treat intoxication with digitoxin, since cross-reaction had been demonstrated in vitro and in animal experiments. The present paper briefly discusses the mode of action and the general problems relating to the antibody therapy of digitalis poisoning.

Topics: Aged; Animals; Digitoxin; Digoxin; Follow-Up Studies; Heart Failure; Humans; Immunoglobulin Fab Fragments; Immunotherapy; Infusions, Parenteral; Male; Platelet Count; Self Administration; Sheep; Thrombocytopenia

Topics: Adult; Aged; Critical Care; Digitoxin; Female; Heart Failure; Humans; Injections, Intravenous; Male; Middle Aged

Topics: Cholestyramine Resin; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Drug Interactions; Heart Failure; Humans; Patient Compliance; Phenobarbital; Quinidine; Rifampin

The narrow therapeutic range of digitalis glycosides and the danger of intoxication has prompted a search for alternative medication in recent years. Substances reducing the pre- and afterload of the heart are suitable therapeutic agents and vasodilators are, therefore, used as adjuvant or alternative therapy. Of all positive inotropic substances only the catecholamines play an established part in the treatment of acute myocardial failure. Pilot studies testing orally administrable positive inotropic substances are being conducted, but for the moment no such drugs are available for routine use. Digitalis still remains the drug of choice for all forms of primary impairment of contractility and/or supraventricular tachyarrhythmias. The appropriate dosage has to be adapted to the estimated lean body mass and, if necessary, reduced in a thin person, Digitoxin is preferentially used in cases with suspected renal insufficiency (especially in elderly patients).

Topics: Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Diuretics; Heart Failure; Heart Rate; Humans; Hyperkalemia; Myocardial Contraction; Vasodilator Agents

Using one- and two-dimensional echocardiographic parameters, left ventricular function and dimensions were investigated in 11 patients with chronic heart failure (NYHA stages II-III) and in 10 normal subjects after administration of low-dose digitoxin (0.07 mg). Tests were performed before the begin of therapy, on the 3rd day following rapid saturation, and on the 15th day under maintenance therapy. There was no significant decrease either of heart volume as assessed by X-ray or of enddiastolic volume measured echocardiographically. However--predominantly in patients--a marked decrease in endsystolic diameter (p less than 0.01) and an increase in posterior wall motion amplitude (p less than 0.05) was observed resulting in increased stroke volume, shortening fraction (p less than 0.001). Early diastolic left ventricular filling speed also increased significantly in both groups (p less than 0.01). Changes in these parameters were more pronounced in patients than in normal subjects. In both groups the effects were achieved soon after rapid saturation, increasing slightly during the period of chronic administration of low-dose digitoxin. Parallel to the changes in echocardiographic parameters, a noticeable clinical improvement occurred among patients. No side effects were observed as serum digitoxin levels were in the therapeutic range. It may be concluded that low-dose digitoxin can be employed to increase cardiac contractility in patients with heart failure.

Topics: Adult; Cardiac Output; Cardiac Volume; Cardiomyopathy, Hypertrophic; Coronary Disease; Digitoxin; Dose-Response Relationship, Drug; Echocardiography; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction

Topics: Animals; Digitalis; Dogs; Electrolytes; Erythrocytes; Heart Failure; Humans; Magnesium; Plants, Medicinal; Plants, Toxic; Sodium-Potassium-Exchanging ATPase

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

Identifying and correcting the cause is the ideal treatment of the clinical syndrome of chronic congestive heart failure. Whenever such an approach is impossible or does not suffice, the next step is to suppress precipitating factors and to prescribe rest, a low salt diet, digitalis and diuretics. If the patient remains symptomatic, vasodilators such as nitrates, hydralazin, prazosin or captopril may be very helpful. The physiopathological basis for a rational and practical approach to these various stages of therapy is reviewed.

Topics: Cardiac Output; Chronic Disease; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Renin-Angiotensin System; Vasodilator Agents

A 2-month-old female infant with congestive heart failure secondary to hepatic hemangiomatosis was treated with prednisone for five weeks without clinical improvement. She then underwent acute cardiac decompensation and required assisted ventilation. The hepatic artery was ligated to decrease the blood supply to the hemangiomata. Although the engorged liver softened dramatically, she continued to require mechanical ventilation for cardiac failure. Ten days postoperatively, she underwent digitalization with significant improvement in cardiac function, and she was then weaned from the respirator. Although, at 2 1/2 years of age, her liver has remained somewhat enlarged, her cardiovascular function has been normal. Our experience indicates that hepatic hemangiomatosis can be successfully treated via hepatic artery ligation and that cardiotonic measures might sometimes be required for recovery from coexisting congestive heart failure.

Topics: Angiomatosis; Digitalis; Female; Heart Failure; Hemangioma; Hepatic Artery; Humans; Infant; Ligation; Liver Neoplasms; Plants, Medicinal; Plants, Toxic; Skin Neoplasms

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

Cardiac glycosides still belong to the most frequently prescribed drugs, although the usefulness of digitalization in patients with sinus rhythm has been repeatedly challenged. In elderly patients, especially, the objective hemodynamic improvement remains minimal and treatment can often be interrupted without subsequent deterioration. On the other hand, signs of digitalis toxicity, such as nausea, vomiting, AV-block, ventricular extrasystoles or CNS-symptoms, occur in 15-30% of patients. Adverse effects are mainly due to toxic accumulation of digoxin in cases with age related reduction of kidney function. In view of its non-renal elimination digitoxin would seem to have a certain advantage in geriatric patients, however, its long t 1/2 (6-7 days) makes dose adjustments more difficult, as peak effects will only be attained after 4-5 weeks. For these reasons digitalis treatment in elderly patients should not be given without clinically manifest congestive heart failure and/or atrial fibrillation. Even in such cases a periodic reassessment of the therapeutic indication is recommended. Suspected "latent" cardiac failure or cerebrovascular insufficiency are no reasons for utilizing such potentially toxic drugs.

Topics: Aged; Aging; Cardiac Complexes, Premature; Creatinine; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Half-Life; Heart Block; Heart Failure; Humans; Kidney

Topics: Aged; Digitoxin; Drug Administration Schedule; Female; Heart Failure; Humans; Male

In three patients with malignant lymphoma who received 0.5 mg digitoxin before and 24 hr after combination therapy with cyclophosphamide, Oncovin, procarbazine, and prednisone (COPP) or cyclophosphamide, Oncovin, and prednisone (COP), plasma glycoside concentrations and renal excretion were measured 0 to 168 hr after digitoxin and the areas under plasma concentration-time curves *(AUCs) were calculated. In 10 patients receiving 0.1 mg digitoxin, daily plasma glycoside concentration and daily renal excretion were measured before and after COPP, COP, or cyclophosphamide, Oncovin, cytosine-arabinoside, and prednisone (COAP) treatment schemes. In contrast to previous reports on digoxin, cytostatic drug therapy does not lead to a reduction in steady-state digitoxin plasma levels and daily renal excretion. During cytostatic therapy attainment of peak digitoxin level was delayed after a single dose, showing that the rate of digitoxin absorption was reduced, but that the AUCs and renal excretion of digitoxin (parameters of the extent of digitoxin absorption) were not diminished. Since the absorption rate is not clinically relevant in patients on long-term glycoside therapy, our results indicate that digitoxin is preferable to digoxin in such patients.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Cytarabine; Digitoxin; Female; Heart Failure; Humans; Leukemia; Lymphoma; Male; Middle Aged; Prednisone; Procarbazine; Vincristine

Topics: Adult; Age Factors; Aged; Biological Availability; Cardiac Glycosides; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Middle Aged; Poisoning; Risk

Topics: Cardiac Glycosides; Digitoxin; Digoxin; Half-Life; Heart Failure; Humans; Kidney; Myocardial Contraction; Proscillaridin; Strophanthins

Topics: Adrenergic beta-Agonists; Animals; Cardiac Glycosides; Cardiotonic Agents; Chick Embryo; Digitalis; Forecasting; Heart; Heart Failure; Hemodynamics; Humans; Plants, Medicinal; Plants, Toxic

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: Digitalis; Heart Failure; Humans; Organomercury Compounds; Oxygen Consumption; Plants, Medicinal; Plants, Toxic; Stroke Volume

Topics: Catecholamines; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

During the last years as a result of improved diagnostic methods and new developed drugs with different mechanism of action the therapy of congestive heart failure has become more differentiated. Digitalis and diuretics constitute conventional therapy, but systemic vasodilators offer an innovative approach in acute and chronic heart failure. The vasodilators produce disparate modifications of cardiac function depending upon their differing alterations of preload and afterload. Nitrates principally cause vasodilation, nitroprusside, phentolamine and prazosin produce balanced arterial and venous dilation, whereas hydralazine predominantly causes arteriolar dilation. New positive inotropic agents like dopamine and dobutamine are still restricted to parenteral use.

Topics: Chronic Disease; Digitalis; Dihydralazine; Heart Failure; Humans; Nitrates; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Pulmonary Heart Disease; Vasodilator Agents

The indications and performance of oral digitalization without saturation dose are evaluated on the basis of clinical parameters and plasma digitalis levels. A group of patients with evident cardiac insufficiency received a daily maintenance dosage of digitalis (2 tablets of 0.1 mg methyldigoxin) from the outset. After 7, 15 and 30 days the plasma concentration of methyldigoxin was measured. Objective and subjective signs of cardiac insufficiency were noted. In 28 of 29 patients the therapeutic plasma level (0.8-2.0 ng/ml) was achieved with a mean plasma digitalis concentration of 1.47 +/- 0.4 ng/ml. A clinical improvement was observed in 18 patients. On the 15th and 30th day of treatment the mean plasma level of methyldigoxin showed no significant difference: X15 = 1.51 +/- 0.57 ng/ml and X30 = 1.40 +/- 0.46 ng/ml. The measured plasma values were not influenced by the patient's weight or age. In 6 patients with renal insufficiency a clear correlation between the plasma level of methyldigoxin and the creatinine level was observed. The evaluation of ECG signs showed only minimal alterations of conduction and repolarisation. On the basis of these results conclusions are drawn with regard to the clinical value and use of this therapy.

Topics: Aged; Digitalis; Digoxin; Heart Failure; Humans; Medigoxin; Plants, Medicinal; Plants, Toxic; Prospective Studies

Topics: Acute Disease; Digitalis; Drug Evaluation; Heart Failure; Hemodynamics; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Cardiac Glycosides; Cardiotonic Agents; Catecholamines; Depression, Chemical; Digitalis; Digoxin; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic; Potassium; Stimulation, Chemical; Xanthines

Topics: Adrenergic beta-Antagonists; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Hyperthyroidism; Kidney Failure, Chronic; Liver Diseases; Quinidine

Topics: Digitoxin; Digoxin; Dose-Response Relationship, Drug; Glycosides; Heart Failure; Humans; Kidney Failure, Chronic; Metabolic Clearance Rate; Proscillaridin; Strophanthins; Uremia

Topics: Biotransformation; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Metabolic Clearance Rate

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: Adult; Aged; Bufanolides; Computers; Digitoxin; Female; Heart Failure; Humans; Male; Mathematics; Middle Aged; Monitoring, Physiologic; Proscillaridin

Patients suffering from congestive heart failure received maintenance doses of digitoxin (N = 10) or digoxin (N = 8). The plasma glycoside concentration was determined, and after a single dose of 3H-digitoxin or 3H-digoxin, the decline and excretion of radioactivity were measured over a period of 7 (digitoxin) and 3 days (digoxin). Plasma radioactivity declined with a T1/2 beta between 77 and 234 h (mean 138 h) in the case of digitoxin and with a T1/2 beta between 9.2 and 38.6 h (mean 23.5 h) for digoxin. A close correlation between T1/2 beta and excreted radioactivity and T1/2 beta and total plasma level was found for digitoxin. In 4 patients TLC of urine showed that interindividual variations in digitoxin elimination could possibly be attributed to variation in metabolism, resulting in the production of different metabolites. Predicted digitoxin plasma levels agreed well with measured values. The maintenance dose could be calculated from the total body clearance (VCl) and a presumed plasma glycoside level. The recommended technique facilitates dosage calculations in patients treated with digitoxin.

Topics: Adult; Digitoxin; Digoxin; Female; Heart Failure; Humans; Kinetics; Male; Middle Aged

Topics: Animals; Calcium; Digitalis; Digitalis Glycosides; Heart; Heart Failure; Humans; Hydrogen Bonding; Plants, Medicinal; Plants, Toxic; Sodium-Potassium-Exchanging ATPase

Topics: Adult; Aged; Arrhythmias, Cardiac; Digitalis; Heart Failure; Humans; Long-Term Care; Male; Middle Aged; Oxygen Inhalation Therapy; Plants, Medicinal; Plants, Toxic; Respiratory Insufficiency; Spironolactone

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

Topics: Aged; Angina Pectoris; Diet, Sodium-Restricted; Digitalis; Diuretics; Heart Failure; Humans; Plants, Medicinal; Plants, Toxic

Topics: Digitalis; Drug Evaluation; Heart Failure; Hemodynamics; Humans; Models, Biological; Myocardial Contraction; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Vasodilator Agents

In a retrospective study conducted in 213 patients with cardiac pacemakers having severe bradycardiac heart failure with oedema, the addition of the aldosterone-antagonist spironolactone to a diuretic therapy was shown to have a favourable influence on the degree of compensation. This has been confirmed in 26 patients under the conditions of a drug interruption period, and in 24 other patients, who were treated with spironolactone after being decompensated under the therapy with digitalis and diuretic or without diuretic. The application of triamterene with a thiazide did not show this positive effect.

Topics: Aged; Digitalis; Diuretics; Female; Heart Failure; Humans; Male; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Retrospective Studies; Spironolactone

Topics: Digitalis; Digitalis Glycosides; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Myocardial Contraction; Plants, Medicinal; Plants, Toxic; Stimulation, Chemical

Topics: Aged; Aging; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digitoxin; Digoxin; Heart; Heart Failure; Humans; Patient Compliance

Topics: Adult; Aged; Animals; Arrhythmias, Cardiac; Digitoxin; Digoxin; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; In Vitro Techniques; Male; Middle Aged; Monitoring, Physiologic; Rabbits

The pharmacodynamic effects (changes of systolic time intervals, STI, reaction of pulmonary arterial pressure) of digitoxin were studied in 7 patients with severe congestive heart failure in comparison with the corresponding plasma level. STI indicated glycoside-dependent changes, i.e. shortening of LVETc and QS2c and normalization of prolonged PEPc, while ICT shortening was less observed. In 2 patients with cor pulmonale a pulmonary oedema occurred accompanied with prolonged LVETc. During the early period of glycoside-dependent recompensation no significant correlation between STI shortening and glycoside plasma level was observed. Because of the retarded normalization of the haemodynamics of the pulmonary circulation and because of possible side-effects, rapid digitalization has to be reconsidered.

Topics: Adult; Aged; Blood Pressure; Digitoxin; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Circulation; Pulmonary Heart Disease

Topics: Cardiac Glycosides; Cardiotonic Agents; Digitoxin; Digoxin; Heart Failure; Humans; Myocardial Contraction

The symptoms and physical findings of congestive heart failure are learned during the early stages of medical education. They are considered prominently in physical diagnosis courses even before a medical student's clinical clerkships begin. Yet, the diagnosis and proper management of congestive heart failure may still represent a challenge even for the most experienced clinician. Obviously, there is more to this syndrome than a collection of symptoms and signs. In fact, it is probably best to reject entirely the concept of congestive heart failure as a syndrome and consider it merely a descriptive term that requires an application of knowledge and skills learned in physiology, pharmacology and clinical medicine if the patient is to receive proper care. Many fine monographs and textbooks have been written about congestive heart failure, from the standpoint of myocardial mechanics, pathophysiology, cardiovascular pharmacology and biochemistry. It is our aim in this monograph to provide clinical insights into the management of congestive heart failure, including such factors as myocardial mechanics and cardiovascular pharmacology only when applicable in a clinical sense. Several cases recently encountered are included to underscore certain concepts.

Topics: Diet, Sodium-Restricted; Digitoxin; Digoxin; Diuretics; Female; Heart Failure; Humans; Male; Vasodilator Agents

Topics: Digitoxin; Digoxin; Female; Heart Failure; Humans; Middle Aged

Topics: Digitoxin; Drug Interactions; Female; Half-Life; Heart Failure; Humans; Middle Aged; Rifampin; Tuberculosis

In 25 digitalized patients with ischaemic heart disease who had survived a myocardial infarction for 2 to 4 weeks, the systolic time intervals (STI) and changes of glycoside plasma level were measured before and up to 5 hrs after oral intake of a maintenance dose of digitoxin (n = 18) or of digoxin (n = 7). Between the changes of STI and the increase in digitoxon and digoxin plasma level no significant correlations were found. Therefore it is concluded that neither shortening of STI during the test period nor PEP/LVET are reliable criteria of individualizing and optimizing the therapy with cardioactive glycosides.

Topics: Adult; Aged; Digitalis Glycosides; Digitoxin; Digoxin; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction

Topics: Adult; Aged; Bufanolides; Digitoxin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Drug Tolerance; Female; Heart Failure; Humans; Lanatosides; Male; Middle Aged; Proscillaridin

Topics: Digitoxin; Digoxin; Dose-Response Relationship, Drug; Half-Life; Heart Failure; Humans; Intestinal Absorption; Kidney Diseases; Protein Binding

Topics: Aged; Arrhythmias, Cardiac; Digitalis; Electrocardiography; Female; Heart Failure; Heart Ventricles; Humans; Plants, Medicinal; Plants, Toxic

This survey deals with the 5 most important internal problems of old aged people undergoing surgery: chronic emphysematous bronchitis, geriatric heart, Diabetes mellitus, bleeding tendency during operation and venous thromboembolism.

Topics: Aged; Bandages; Blood Coagulation Disorders; Bronchitis; Diabetes Mellitus; Digitoxin; Digoxin; Emphysema; Exercise Therapy; Heart Failure; Humans; Hypoglycemic Agents; Preoperative Care; Respiratory Therapy; Strophanthins; Thromboembolism

Topics: Aged; Anorexia; Arrhythmias, Cardiac; Deglutition Disorders; Digitalis Glycosides; Digitoxin; Digoxin; Female; Heart Failure; Humans; Male

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Methods

Topics: Administration, Oral; Animals; Digitoxin; Digoxin; Dog Diseases; Dogs; Female; Heart Failure; Male; Vomiting

Topics: Digitoxin; Heart Failure; Humans; Liver Cirrhosis

Topics: Adult; Aged; Animals; Blood Pressure; Digitoxin; Digoxin; Dogs; Echocardiography; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Muscle Proteins; Myocardium; Rabbits

Digitoxin concentration, measured by radio-immunoassay, was significantly lower in 51 patients in chronic renal failure (23.2 +/- 7.8 mug/l) than in 29 patients in heart failure (26.5 +/- 7.3 mug/l), although both groups were on the same maintenance dose of 0.1 mg daily. Despite a normal serum albumin concentration, digitoxin protein binding was less in uraemic patients than in those with normal renal function. Renal failure did not affect intestinal digitoxin absorption. In patients in chronic renal failure elimination half-time was significantly shorter (5.7 +/- 0.9 days) than in healthy controls (7.6 +/- 1.6 days). There was no significant difference in the excretion of water-soluble ("cardioinactive") digitoxin metabolites in urine between patients in chronic renal and those in heart failure. In patients with normal renal function, of dichloromethane-soluble (cardioactive) metabolites only digitoxin could be demonstrated by thin-layer chromatography. The results indicate that patients in chronic renal failure can safely be given the same dose as those with normal renal function, without danger of over- or underdosage.

Topics: Adult; Aged; Digitoxin; Female; Half-Life; Heart Failure; Humans; Intestinal Absorption; Kidney Failure, Chronic; Kinetics; Male; Middle Aged; Radioimmunoassay; Serum Albumin

It is the bicentennial anniversary of the introduction of digitalis into medicine. Digitalis is one of the most important drugs ever discovered, and after two centuries, it is still the most widely used drug in cardiology. However, it was at one time so badly abused that for nearly a century it was almost abandoned. Early in this century, the valuable effects of digitalis were once again recognized and extended. The molecular basis of action has been defined and now methods are available to detect early toxicity. Recent advances in combating toxic effects show considerable promise. Skillful administration of the drug, using purified standard tablets, careful monitoring by clinical electrocargiography, and analytical methods can secure the maximun benefits with the minimum degree of toxicity.

Topics: Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Digoxin; England; Heart; Heart Failure; History, 18th Century; Humans; Intestinal Absorption; Intestines; Ischemia; Pacemaker, Artificial; Suicide; Tablets; Time Factors

To determine the effect of prolonged digitoxin administration on contractile function of nonfailing myocardium, right ventricular papillary muscle mechanics were examined after 6 or 24 wk of glycoside administration to control and pulmonary artery banded cats. Resting length-tension relations were not affected by digitoxin; however, isometrically developed force and the maximal rate of force development at the peak of the length-tension curve were increased in all treated groups. In untreated animals, banding resulted in a 28% incidence of deaths from heart failure. 6 wk after constriction, contractile function was depressed whereas normal function was observed 24 wk after banding. Digitoxin significantly reduced mortality from heart failure and enhanced the recovery of contractile function; contractile function in the 6 wk banded treated group approached that of untreated control and 24-wk banded groups. The long-term effects of digitoxin on contractile function were not importantly related to the temporal association between banding and institution of glycoside administration. Development of myocardial hypertrophy was comparable in treated and untreated banded groups.These results demonstrate that a significant positive inotropic effect persists in both normal and nonfailing hypertrophied myocardium during chronic digitoxin administration.

Topics: Animals; Body Weight; Cardiac Output; Cardiac Volume; Cardiomegaly; Cats; Digitoxin; Disease Models, Animal; Heart Failure; Myocardial Contraction; Papillary Muscles; Stimulation, Chemical; Time Factors

Serum digitoxin levels were measured in 18 infants (under two years) and in 23 children (aged 2-13 years) receiving maintenance therapy. Digitalization was carried out because of heart failure in 17 infants and 13 children and for control of dysrhythmia in one infant and 10 children. Mean maintenance dosage for infants was 0.0042 plus or minus 0.0008 (sd) mg/kg/day and for children was 0.0031 plus or minus 0.0012 mg/kg/day. The mean serum digitoxin level was not significantly different in infants (30 plus or minus 10 ng/ml, range 14-58) from that found for children (34 plus or minus 11 ng/ml, range 19-61). Both values were significantly different (P smaller than 0.001) from those determined in this laboratory for adults (mean 24 plus or minus 7 ng/ml, range 5-39). In four infants with electrocardiographic or other evidence of toxicity, the mean serum level was 71 plus or minus 2 ng/ml (range 68-72), and in four children with electrocardiographic or other evidence of toxicity, the mean serum level for digitoxin was 72 plus or minus 14 ng/ml (range 53-84). The data suggest that infants and children tolerate a higher serum digitoxin concentration without any evidence of toxicity and may require more digitoxin (mg/kg) for therapeutic effect than do adults. Serum digitoxin levels may serve as an important guide in determining the adequacy of digitalization and in the recognition and management of digitalis toxicity.

Topics: Adolescent; Age Factors; Arrhythmias, Cardiac; Body Weight; Child; Child, Preschool; Digitoxin; Electrocardiography; Heart; Heart Failure; Humans; Infant; Radioimmunoassay

The pharmacokinetics of digoxin and digitoxin in patients undergoing long-term hemodialysis were examined to determine which is the preferred cardiac glycoside in this patient population. Absorption curves from 0 to 24 hours after an oral dose of digitoxin were similar in dialyzed patients and in control patients. Serum glycoside concentrations after an oral dose of digoxin were higher in dialyzed patients than in control patients, significantly so from 2 to 24 hours, reflecting the absence of the predominantly renal route of excretion of digoxin. When nine dialyzed patients were placed on a maintenance dose of digoxin, 0.125 mg 5 days a week, serum levels plateaued at 30 days at a mean concentration (plus or minus SE) of 0.84 plus or minus 0.05 ng/ml. Maintenance therapy with 0.1 mg digitoxin 5 days a week resulted in stabilization of serum levels within 30 days at a mean concentration of 19 plus or minus 1 ng/ml. Variability in the serum glycoside concentrations was determined after stabilization of levels during 2 to 19 week follow-up periods with each drug. Variability in serum levels was somewhat increased during maintenance therapy with digitoxin. On the basis of the parmacokinetic data obtained in this study, no clear cut preference for one glycoside over the other could be established.

Topics: Adult; Digitoxin; Digoxin; Heart Failure; Humans; Kidney Failure, Chronic; Kinetics; Middle Aged; Renal Dialysis

Topics: Adult; Digitoxin; Digoxin; Female; Heart Failure; Humans; Male; Radioimmunoassay

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

Plasma digoxin and digitoxin determination has proven to have an important bearing, particularly in patients with renal failure. It permits early detection of digitalis intoxication in the absence of marked clinical and ECG evidence, and adjustment of dosage accordingly. Also, in patent intoxication it makes it possible to select the right moment for resumption of therapy. To illustrate the importance of the method some cases are cited involving plasma digoxin and digitoxin determination.

Topics: Acute Kidney Injury; Bradycardia; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Kidney Failure, Chronic

Topics: Adult; Digitoxin; Digoxin; Heart Failure; Humans; Hypertension; Kidney Diseases; Male; Middle Aged; Renal Dialysis

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

Intrarenal distribution of blood flow was measured by the 133xenon washout curve in 33 patients with heart disease. Plasma renin activity and sodium concentration were also measured on the day when the xenon study was performed. The patients were divided into three groups according to cardiac index: Group I whose cardiac index showed higher than 3.50 1/min/M2, BSA, group II whose index ranged from 2.50 to 3.50, and group III who had lower than 2.50. Total renal blood flow was significantly decreased in group II (p less than 0.001), as compared with normal controls. The percents of the total renal blood flow supplied to component I decreased significantly in group I, II (p less than 0.05) and group III (p less than 0.01). The flow rate in component I decreased significantly only in group II (p less than 0.05) and group III (p less than 0.01). There was a significant increase in the percent distribution of component II in group II (p less than 0.05) and in group III (p less than 0.01). The flow rate of component II showed a slight increase in group I and III. The study of autoradiographs done in dogs with heart failure demonstrated that component I corresponded to a cortical area having a relatively faster flow rate, whereas component II corresponded to the cortical area which was perfused more slowly. Accordingly, component III indicated outer medulla. There was no apparent relation between intrarenal distribution of blood flow and plasma renin activity although the latter tended to be elevated in patients treated with diuretics. In view of the data available it was concluded that outer cortical as well as outer medullary blood flow are decreased in chronic congestive heart failure and that there is no apparent correlation between outer cortical flow and plasma renin activity.

Topics: Adult; Animals; Autoradiography; Blood Flow Velocity; Cardiac Output; Chronic Disease; Digitalis; Diuretics; Dogs; Female; Heart Failure; Humans; Kidney; Kidney Cortex; Kidney Medulla; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Radiography; Regional Blood Flow; Renal Artery; Renin; Sodium

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: Aged; Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Digoxin; Heart Block; Heart Failure; Heart Valve Diseases; Humans; Middle Aged; Myocardial Infarction; Potassium Deficiency; Strophanthins

Topics: Adult; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Dose-Response Relationship, Drug; Female; Heart Failure; Heart Rate; Humans; Lanatosides; Potassium Deficiency; Water-Electrolyte Balance

Topics: Aged; Blood Urea Nitrogen; Body Weight; Digitalis; Diuretics; Female; Furosemide; Heart Failure; Hematocrit; Humans; Hydrochlorothiazide; Infarction; Ischemia; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Organomercury Compounds; Plants, Medicinal; Plants, Toxic; Sodium Chloride Symporter Inhibitors; Triamterene

Topics: Apnea; Digitalis; Diuretics; Ductus Arteriosus, Patent; Female; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Respiratory Distress Syndrome, Newborn

Topics: Arrhythmia, Sinus; Atrial Fibrillation; Atropine; Digitalis; Electrocardiography; Female; Heart Block; Heart Failure; Humans; Isoproterenol; Male; Pacemaker, Artificial; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prospective Studies; Syncope; Tachycardia

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: Animals; Digitoxin; Digoxin; Dog Diseases; Dogs; Female; Heart Failure; Male

Topics: Digitoxin; Digoxin; Drug Interactions; Heart Failure; Humans; Protein Binding

Topics: Aged; Blood Urea Nitrogen; Calcium; Coronary Disease; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Evaluation Studies as Topic; Heart Failure; Heart Valve Diseases; Humans; Kidney Failure, Chronic; Middle Aged; Myocardial Infarction; Photometry; Potassium; Radioimmunoassay; Saliva; Specimen Handling; Spectrophotometry, Atomic

Topics: Blood Proteins; Blood Urea Nitrogen; Digitalis Glycosides; Digitoxin; Diuretics; Electrolytes; Heart; Heart Failure; Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Radiography; Rheumatic Heart Disease

Topics: Atrial Fibrillation; Digitoxin; Electric Countershock; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Ligation; Middle Aged; Pacemaker, Artificial; Recurrence; Sutures; Syncope

Topics: Acetylation; Adult; Aged; Digitoxin; Drug Synergism; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Strophanthins

Topics: Animals; Aortic Valve Stenosis; Autoradiography; Cardiac Glycosides; Digitoxin; Digoxin; Heart Failure; Histocytochemistry; Male; Microscopy, Electron; Myocardium; Rabbits; Tritium

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: Adenosine Triphosphatases; Adolescent; Adult; Age Factors; Animals; Calcium; Cell Membrane; Child; Child, Preschool; Digitalis; Digitalis Glycosides; Digoxin; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Diseases; Myocardium; Ouabain; Plants, Medicinal; Plants, Toxic; Sodium; Tritium

Topics: Antihypertensive Agents; Bloodletting; Bronchodilator Agents; Digitalis; Digoxin; Furosemide; Heart Failure; Heroin; Hospitalization; Humans; Intensive Care Units; Mitral Valve Insufficiency; Mitral Valve Stenosis; Morphine; Oxygen Inhalation Therapy; Phytotherapy; Plants, Medicinal; Plants, Toxic; Positive-Pressure Respiration; Posture; Pulmonary Edema; Respiration, Artificial; Tourniquets; Venous Pressure

Topics: Adult; Aged; Blood Pressure; Digitalis; Diuretics; Guanethidine; Heart; Heart Failure; Heart Rate; Humans; Hypertension; Male; Middle Aged; Muscle Contraction; Plants, Medicinal; Plants, Toxic; Reserpine; Sympathetic Nervous System; Sympatholytics; Vascular Resistance

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

Topics: Adult; Anger; Attitude of Health Personnel; Child Psychiatry; Chronic Disease; Cystic Fibrosis; Death; Digitalis; Fear; Grief; Guilt; Heart Failure; Humans; Male; Parent-Child Relations; Pediatrics; Physician-Patient Relations; Phytotherapy; Plants, Medicinal; Plants, Toxic; Sleep Wake Disorders; Terminal Care

Topics: Aged; Atrial Fibrillation; Bronchopneumonia; Cardiovascular Diseases; Digitalis; Diuretics; Electrocardiography; Endocarditis, Subacute Bacterial; Female; Heart Block; Heart Failure; Heart Septal Defects; Humans; Myocardial Infarction; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Pulmonary Heart Disease; Radiography

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: Adult; Blood Pressure; Cardiac Output; Child; Computers; Digitalis; Digoxin; Female; Heart Failure; Heart Rate; Heart Ventricles; Humans; Male; Myocardium; Plants, Medicinal; Plants, Toxic

Topics: Aged; Atrial Fibrillation; Cheyne-Stokes Respiration; Digitoxin; Heart Failure; Heart Ventricles; Humans; Male; Respiration

Topics: Cardiac Output; Digitoxin; Digoxin; Heart; Heart Failure; Heart Rate; Humans; Myocardial Infarction; Potassium Chloride; Shock, Cardiogenic

Topics: Adult; Aged; Digitoxin; Heart Failure; Humans; Male; Middle Aged

Topics: Animals; Diet, Sodium-Restricted; Digitoxin; Digoxin; Dog Diseases; Dogs; Furosemide; Heart Failure; Surveys and Questionnaires; Thiazines; United States; Veterinary Medicine

Topics: Digitoxin; Electrocardiography; Female; Growth Disorders; Heart Atria; Heart Failure; Humans; Hyperthyroidism; Infant, Newborn; Long-Acting Thyroid Stimulator; Male; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Paroxysmal; Thyrotropin

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: Adult; Aged; Antibody Specificity; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Cholesterol; Dehydroepiandrosterone; Digitoxin; Digoxin; Electrocardiography; Estradiol; Female; Heart Block; Heart Failure; Humans; Hydrocortisone; Male; Mathematics; Methods; Middle Aged; Progesterone; Radioimmunoassay; Tachycardia; Testosterone; Tritium

Topics: Administration, Oral; Arrhythmias, Cardiac; Cardiac Glycosides; Diet Therapy; Digitoxin; Digoxin; Diuresis; Drug Tolerance; Edetic Acid; Electrocardiography; Gastrointestinal Diseases; Heart Failure; Heart Rate; Humans; Injections, Intravenous; Lanatosides; Nervous System Diseases; Phytotherapy; Plants, Medicinal; Poisoning; Potassium; Rest; Strophanthins

Topics: Administration, Oral; Animals; Atrial Fibrillation; Cardiac Catheterization; Digitoxin; Digoxin; Dog Diseases; Dogs; Electrocardiography; Glycosides; Heart Failure; Heart Function Tests; Heart Ventricles; Injections, Intravenous; Intestinal Absorption; Ventricular Function

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: Aged; Aortic Valve Insufficiency; Digitoxin; Digoxin; Ethacrynic Acid; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Oxygen Inhalation Therapy; Pulmonary Heart Disease; Spironolactone

Topics: Cardiac Glycosides; Digitoxin; Digoxin; Diuretics; Heart Failure; Heart Rate; Humans; Lanatosides; Strophanthins; Time Factors

Topics: Acetates; Administration, Oral; Adult; Aged; Ambulatory Care; Digitoxin; Female; Heart Failure; Humans; Male; Middle Aged

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

Topics: Adolescent; Cardiac Complexes, Premature; Digitalis; Electrocardiography; Female; Heart Atria; Heart Failure; Humans; Middle Aged; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Aged; Digitoxin; Enterocolitis, Pseudomembranous; Female; Gastrointestinal Hemorrhage; Germany, West; Heart Failure; Humans; Infant, Newborn; Jejunum; Lanatosides

Topics: Digitoxin; Digoxin; Drug Tolerance; Heart Failure; Humans; Kidney Failure, Chronic; Renal Dialysis; Strophanthins; Uremia

Topics: Digitoxin; Digoxin; Heart Failure; Humans; Lanatosides

Topics: Adams-Stokes Syndrome; Arrhythmias, Cardiac; Cardiac Glycosides; Digitoxin; Heart Block; Heart Failure; Heart Rate; Humans; Pacemaker, Artificial; Procainamide; Sympatholytics; Tachycardia

Topics: Blood Cell Count; Blood Platelets; Digitoxin; Furosemide; Heart Failure; Humans; Thrombocytopenia

Topics: Animals; Arrhythmias, Cardiac; Cardiac Glycosides; Cats; Digitoxin; Female; Heart; Heart Failure; Lanatosides; Male; Strophanthins

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digitalis; Electric Countershock; Electrocardiography; Heart Conduction System; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Cardiac Complexes, Premature; Digitoxin; Electric Countershock; Electrocardiography; Electrolytes; Embolism; Female; Heart Failure; Heart Septal Defects, Atrial; Heparin; Humans; Hypokalemia; Intracranial Embolism and Thrombosis; Male; Middle Aged; Mitral Valve Stenosis; Postoperative Complications; Pulmonary Embolism; Quinidine; Spironolactone; Water-Electrolyte Balance

Topics: Atrial Flutter; Calcium; Cardiac Complexes, Premature; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Lanatosides; Long-Term Care; Ouabain; Quinidine; Tachycardia

Topics: Digitoxin; Digoxin; Heart Failure; Humans; Tritium

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Child; Digitoxin; Female; Heart Failure; Humans; Male; Middle Aged

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: Ampicillin; Anemia, Hypochromic; Animals; Anticoagulants; Blood Cell Count; Blood Coagulation Tests; Blood Preservation; Blood Transfusion; Digitoxin; Epistaxis; Fibrinogen; Heart Failure; Hematocrit; Hemoglobinometry; Humans; Immunoelectrophoresis; Immunoglobulin G; Infant; Male; Plasma; Shock, Hemorrhagic; Thrombocytopenia

Topics: Adolescent; Adult; Anesthesia, Inhalation; Blood Transfusion; Digitoxin; Female; Heart Failure; Humans; Isoproterenol; Methoxyflurane; Shock, Hemorrhagic; Vasodilator Agents

Topics: Chromatography, Thin Layer; Digitoxin; Electrocardiography; Fluorometry; Heart Failure; Humans; Methods; Strophanthins

Topics: Digitoxin; Digoxin; Heart Failure; Humans; Injections, Intravenous; Lanatosides; Phytotherapy; Plants, Medicinal; Strophanthins; Tablets

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts; Plants, Medicinal; Plants, Toxic

Topics: Adolescent; Age Factors; Body Surface Area; Child; Child, Preschool; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Female; Heart Failure; Humans; Infant; Lanatosides; Male; Strophanthins

Topics: Atrial Fibrillation; Digitoxin; Female; Heart Failure; Humans; Hyperthyroidism; Iatrogenic Disease; Middle Aged; Tachycardia

Topics: Cardiac Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Hypertension; Lanatosides; Male; Middle Aged; Postoperative Care; Preoperative Care; Strophanthins; Sympathectomy

Topics: Atrial Fibrillation; Coronary Disease; Digitalis Glycosides; Digitoxin; Electrocardiography; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Time Factors

Topics: Aged; Blood Pressure; Digitoxin; Female; Heart Failure; Humans; Injections, Intravenous; Male; Middle Aged; Veins

Topics: Animals; Cardiac Glycosides; Digitoxin; Dogs; Heart Failure; Humans; Kinetics; Tritium

Topics: Animals; Chromatography, Thin Layer; Countercurrent Distribution; Digitoxin; Female; Heart Failure; Rabbits; Tritium

Topics: Aged; Cardiac Glycosides; Digitoxin; Digoxin; Female; Heart Failure; Humans; Lanatosides; Male; Middle Aged; Strophanthins

Topics: Animals; Blood Pressure; Digitalis Glycosides; Digitoxin; Heart Failure; Hypertension, Renal; Male; Rats

Topics: Adult; Digitoxin; Electrocardiography; Female; Heart Failure; Hemochromatosis; Humans; Insulin; Kymography; Liver

Topics: Animals; Aortic Valve Insufficiency; Aortic Valve Stenosis; Body Weight; Columbidae; Coronary Disease; Digitoxin; Heart Failure; Heart Rate; Heart Septal Defects, Atrial; Humans; Hypertension; Hyperthyroidism; Mitral Valve Stenosis; Pericarditis, Constrictive; Pulmonary Heart Disease

Topics: Animals; Biological Assay; Cardiac Glycosides; Cardiovascular System; Digitoxin; Guinea Pigs; Halothane; Heart Failure; Methods; Phytotherapy; Plants, Medicinal; Strophanthins

Topics: Aged; Aldosterone; Aminophylline; Digitalis; Diuretics; Heart Failure; Humans; Hypertension; Organomercury Compounds; Plants, Medicinal; Plants, Toxic; Prognosis

Topics: Aged; Animals; Cardiac Glycosides; Cardiac Output; Cats; Digitoxin; Guinea Pigs; Heart Failure; Humans; In Vitro Techniques; Phytotherapy; Plants, Medicinal; Pulmonary Heart Disease; Strophanthins

Topics: Animals; Diet, Sodium-Restricted; Digitoxin; Dog Diseases; Dogs; Heart Failure; Radiography, Thoracic

Topics: Animals; Digitoxin; Digoxin; Dog Diseases; Dogs; Electrocardiography; Female; Heart Failure; Heart Rate; Male

Topics: Digitoxin; Heart Failure; Humans; Hungary; Statistics as Topic

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

Topics: Arrhythmias, Cardiac; Digitoxin; Drug Therapy; Electrocardiography; Heart; Heart Failure; Humans; Strophanthins

Topics: Cardiac Glycosides; Digitalis Glycosides; Digitoxin; Heart Failure; Humans

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Drug Therapy; Heart Failure; Humans

Topics: Acetyldigitoxins; Biomedical Research; Digitoxin; Digoxin; Drug Therapy; Heart Failure; Humans; Lanatosides; Toxicology

Topics: Animals; Cardiomegaly; Digitoxin; Heart Failure; Hypertension; Rats

Topics: Anesthesia, Inhalation; Animals; Cardiovascular Diseases; Digitoxin; Guinea Pigs; Halothane; Heart Failure

Topics: Digitoxin; Heart Failure; Humans

Topics: Aged; Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Digoxin; Diuretics; Geriatrics; Gynecomastia; Heart Failure; Humans; Male; Psychoses, Substance-Induced; Psychotic Disorders; Toxicology

Topics: Aged; Diagnosis; Diet, Sodium-Restricted; Digitalis; Digitalis Glycosides; Diuretics; Drug Therapy; Geriatrics; Heart Failure; Humans; Mental Disorders; Plant Extracts; Rest; Surgical Procedures, Operative; Therapeutics

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Electrocardiography; Heart Conduction System; Heart Failure; Humans; Postoperative Care; Preoperative Care

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart Failure; Toxicology

Topics: Arrhythmias, Cardiac; Bronchitis; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digoxin; Electrocardiography; Geriatrics; Heart Conduction System; Heart Failure; Humans; Hypertension; Poisoning; Toxicology

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

Topics: Digitalis; Electrolytes; Guinea Pigs; Heart Failure; Hemodynamics; Hyperkalemia; Hypokalemia; Metabolism; Myocardium; Pharmacology; Potassium; Sodium; Strophanthins; Toxicology

Topics: Ascites; Cardiomegaly; Chlorothiazide; Digitoxin; Diuretics; Electrocardiography; Endocardial Fibroelastosis; Heart Atria; Heart Failure; Humans; Organomercury Compounds; Pathology

Topics: Aneurysm, False; Anticoagulants; Cardiomegaly; Digitoxin; Heart Aneurysm; Heart Failure; Heart Ventricles; Humans; Infarction; Myocardial Infarction; Pathology; Pericardium; Quinidine

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

Topics: Adolescent; Child; Diet; Diet Therapy; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Heart Failure; Humans; Infant; Lanatosides; Rest

Topics: Arteritis; Child; Digitoxin; Endocardial Fibroelastosis; Heart Failure; Hemoptysis; Hemosiderosis; Hemosiderosis, Pulmonary; Humans; Hydrochlorothiazide; Lung Diseases; Pathology; Prednisolone

Topics: Digitoxin; Geriatrics; Heart; Heart Failure; Humans; Tissue Extracts

Topics: Blood Pressure; Child; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Drug Therapy; Fluid Therapy; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Humans; Infant; Lanatosides; Liver Circulation; Morphine; Oxygen Inhalation Therapy; Parenteral Nutrition; Posture; Respiratory Tract Infections; Rest; Shock; Sodium; Water-Electrolyte Balance

Topics: Digitoxin; Drug Synergism; Heart Failure; Humans; Metabolism; Myocardium; Tissue Extracts

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

Topics: Acetazolamide; Aminophylline; Ammonium Chloride; Cardiac Catheterization; Digitalis; Digoxin; Diuretics; Geriatrics; Heart Failure; Heart Function Tests; Hemodynamics; Organomercury Compounds; Oximetry

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: Adolescent; Autopsy; Cardiac Catheterization; Child; Dexamethasone; Digitalis; Digitalis Glycosides; Heart Defects, Congenital; Heart Failure; Heart Septal Defects; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Lanatosides; Pathology; Phonocardiography; Pneumonia; Prednisolone; Rheumatic Fever; Rheumatic Heart Disease; Statistics as Topic; Toxicology

Topics: Blood Flow Velocity; Digitalis; Forearm; Guanethidine; Heart Failure; Humans; Ouabain; Pharmacology; Plethysmography; Strophanthins; Vascular Resistance; Veins

Topics: Diet; Diet Therapy; Digitalis; Digitalis Glycosides; Diuretics; Electrocardiography; Heart Failure; Humans; Hyperthyroidism; Hypokalemia; Hyponatremia; Radiography, Thoracic

Topics: Child; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Infant; Infant, Newborn

Topics: Acute Kidney Injury; Adolescent; Anemia, Hemolytic; Antistreptolysin; Blood Transfusion; Bone Marrow Examination; Child; Dialysis; Diet; Diet Therapy; Digitalis; Electrocardiography; Electroencephalography; Electrophoresis; Erythrocytes; Heart Failure; Hemolytic-Uremic Syndrome; Humans; Infant; Kidney; Neurologic Manifestations; Pathology; Prednisone; Renal Dialysis; Renal Insufficiency; Statistics as Topic; Thrombocytopenia; Uremia; Water-Electrolyte Balance

Topics: Adrenal Cortex Hormones; Aldosterone; Anura; Blood Chemical Analysis; Body Weight; Desoxycorticosterone; Digitalis; Diuretics; Edema; Electrolytes; Heart Failure; Humans; Hydroflumethiazide; Potassium; Research; Sodium; Urine

Topics: Diagnosis, Differential; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Lung Neoplasms; Radiography, Thoracic

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

Topics: Chlorthalidone; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Metabolism; Potassium; Sodium

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Pharmacology; Strophanthins; Toxicology

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Pharmacology; Plant Extracts; Toxicology

Topics: Blood Transfusion; Cardiac Surgical Procedures; Child; Diet, Sodium-Restricted; Digitalis; Digitalis Glycosides; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Polycythemia; Statistics as Topic; Thoracic Surgery

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: Anemia, Sickle Cell; Black People; Cardiomegaly; Child; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Failure; Humans; Hypertension; Hypertension, Pulmonary

Topics: Angina Pectoris; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Hyperthyroidism; Iodine Isotopes; Morbidity; Mortality; Tachycardia; Tachycardia, Paroxysmal

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

Topics: Adrenergic Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Electrocardiography; Ethanolamines; Geriatrics; Heart Block; Heart Failure; Hypotension; Myocardial Infarction; Nausea; Paresthesia; Sympatholytics; Toxicology; Vertigo; Vomiting

Topics: Animals; Anti-Bacterial Agents; Diagnosis, Differential; Digitalis; Digitalis Glycosides; Diuretics; Epidemiology; Heart Failure; Humans; Hypertension, Pulmonary; Iraq; Lung Diseases, Parasitic; Oxygen Inhalation Therapy; Pulmonary Heart Disease; Schistosoma haematobium; Schistosomiasis

Topics: Body Fluids; Digitalis; Digitalis Glycosides; Drug Tolerance; Fluids and Secretions; Heart Failure; Metabolism; Plant Extracts; Toxicology; Urine

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

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Electrocardiography; Heart Failure; Heart Function Tests; Phonocardiography; Systole; Toxicology

Topics: Adenosine Triphosphate; Animals; Calcium; Coenzymes; Digitalis; Digitalis Glycosides; Diuresis; Drug Therapy; Guinea Pigs; Heart Failure; Humans; Hypertension; Metabolism; Myocardial Infarction; Myocardium; Pharmacology

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart Failure; Plant Extracts

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Digoxin; Drug Therapy; Heart Failure; Plant Extracts

Topics: Acetyldigoxins; Biomedical Research; Digitoxin; Heart Failure; Humans

Topics: Acetyldigitoxins; Cardiology; Digitoxin; Heart Failure; Humans

Topics: Diagnosis, Differential; Digitoxin; Diuretics; Heart Failure; Humans; Morphine; Physiology

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Lanatosides; Strophanthins

Topics: Cardiotonic Agents; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Lanatosides; Strophanthins

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

Topics: Anti-Arrhythmia Agents; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Vasodilator Agents

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

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Heart Failure; Pantothenic Acid; Plant Extracts

Topics: Digitalis; Heart Failure; Humans; Lung Diseases; Pulmonary Heart Disease

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart Failure; Humans

TREATMENT OF CARDIAC FAILURE CONSISTS OF THREE PRINCIPAL METHODS OR A COMBINATION OF THEM: (a) rest, or reduction of overload; (b) diuretic therapy and sodium restriction, and (c) administration of digitalis. In a series of patients treatment with the aid of the first two methods was compared with the effect of adding digitalis to this regimen.Clinically, most patients can be brought back to a state of compensation without the use of digitalis. Hemodynamically, digitalis exerts a further favorable action by improving cardiac performance. The discrepancy between clinical and hemodynamic cardiac state is emphasized, for patients may have no clinical evidence of cardiac failure and yet show hemodynamic abnormalities characteristic of serious impairment of cardiac performance. Thus digitalis has been shown to exert a favorable effect in cardiac failure even if such an effect cannot be clinically assessed.

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Homeostasis; Humans; Sodium

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts; Rheumatic Diseases; Rheumatic Fever

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Electrocardiography; Esophageal Neoplasms; Geriatrics; Heart Failure; Humans; Lung Neoplasms; Mortality; Surgical Procedures, Operative; Thoracotomy; Thorax

Topics: Africa; Anemia; Anemia, Sickle Cell; Child; Digitalis; Digitalis Glycosides; Fever; Heart Failure; Infant; Infant, Newborn; Infant, Premature; Kwashiorkor; Myocarditis; Pediatrics; Potassium Deficiency; Toxicology; Tropical Medicine

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Humans; Hyperthyroidism

Topics: Child; Diagnosis, Differential; Diet, Sodium-Restricted; Digitalis; Digitalis Glycosides; Disease Management; Diuretics; Electrocardiography; Heart Failure; Humans; Infant

Topics: Bronchial Diseases; Digitalis; Digitalis Glycosides; Digoxin; Heart Failure; Humans; Lung Diseases

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Electric Countershock; Heart Block; Heart Failure; Humans; Hypokalemia; Potassium; Procainamide; Resuscitation; Tachycardia; Tachycardia, Paroxysmal; Toxicology

Topics: Angiotensins; Blood Pressure; Blood Volume; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Myocardial Infarction; Nikethamide; Norepinephrine; Pentylenetetrazole; Sympathomimetics; Vasodilator Agents

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

Topics: Atrial Fibrillation; Atrial Flutter; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Failure; Humans; Myocardial Infarction; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal

Topics: Anemia; Coronary Disease; Diagnosis, Differential; Digitalis; Digitalis Glycosides; Geriatrics; Heart Failure; Humans; Hyperthyroidism; Lung Diseases; Myxedema; Nephrosis; Pulmonary Embolism; Rheumatic Heart Disease; Water-Electrolyte Balance

Topics: Cardiotonic Agents; Chlorothiazide; Digitoxin; Diuretics; Heart Failure; Humans; Hypnotics and Sedatives; Tranquilizing Agents

Topics: Acetyldigitoxins; Digitoxin; Heart Failure; Humans

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides

Topics: Digitalis; Electrocardiography; Heart Failure; Humans

Topics: Aortic Valve; Bicuspid Aortic Valve Disease; Coronary Disease; Digitalis; Disease; Electrocardiography; Heart Defects, Congenital; Heart Failure; Heart Valve Diseases; Humans

Topics: Digitalis; Digoxin; Heart Failure; Plant Extracts

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

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

Topics: Blood Circulation; Blood Pressure; Blood Pressure Determination; Digitalis; Digoxin; Heart Failure; Hemodynamics

Topics: Biomedical Research; Digitalis; Digoxin; Heart Failure; Plant Extracts

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

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

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Glycosides; Heart Failure

Topics: Cardiac Glycosides; Cardiotonic Agents; Convallaria; Digitalis; Digitalis Glycosides; Glycosides; Heart Failure; Strophanthins

Topics: Digitalis; Heart Failure

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Humans

Topics: Child; Chlorothiazide; Digitalis; Heart Failure; Humans; Infant; Plant Extracts

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

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

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

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Esophagus; Heart Failure; Humans; Lung; Pulmonary Surgical Procedures

Topics: Barbiturates; Cardiotonic Agents; Deslanoside; Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides

Topics: Action Potentials; Barbiturates; Calcium; Digitalis; Digitalis Glycosides; Digitoxigenin; Guinea Pigs; Heart Atria; Heart Failure; Hyperthyroidism

Topics: Action Potentials; Barbiturates; Calcium; Calcium Metabolism Disorders; Digitalis; Digitalis Glycosides; Digitoxigenin; Guinea Pigs; Heart Atria; Heart Failure; Hyperthyroidism

Topics: Administration, Oral; Anti-Arrhythmia Agents; Cardiac Glycosides; Cardiotonic Agents; Digitalis; Diuretics; Glycosides; Heart Failure; Humans

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

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

Topics: Digitalis; Digitalis Glycosides; Glycosides; Heart; Heart Failure; Myocardium

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

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

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

Topics: Digitalis; Digoxin; Heart; Heart Failure; Humans; Male; Ventricular Dysfunction, Right

Topics: Child; Digitalis; Heart Defects, Congenital; Heart Failure; Humans; Infant

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

Topics: Chlormerodrin; Diet; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Organomercury Compounds; Sodium Chloride; Treatment Outcome

Topics: Digitalis; Heart Failure; Humans; Tachycardia; Tachycardia, Supraventricular

Topics: Acetyldigitoxins; Atrial Fibrillation; Digitalis; Heart Failure; Humans

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

Topics: Anti-Arrhythmia Agents; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Phenylbutazone

Topics: Cardiotonic Agents; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Plant Extracts

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

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts; Reserpine

Topics: Digitalis; Heart Failure

Topics: Blood Proteins; Chronic Disease; Digitalis; Diuretics; Heart Failure; Humans; Organomercury Compounds; Plant Extracts

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

Topics: Digitalis; Glycosides; Heart Failure; Humans; Purines; Vasoconstrictor Agents; Vasodilator Agents

Topics: Aged; Digitalis; Geriatrics; Heart Failure; Humans; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Electrolytes; Glutamates; Glutamic Acid; Heart Failure; Lanatosides; Water-Electrolyte Balance

Topics: Digitalis; Digitalis Glycosides; Glycosides; Heart Failure; Hemodynamics; Humans; Plant Extracts; Strophanthins

Topics: Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Mersalyl; Organomercury Compounds; Plant Extracts; Strophanthins; Thrombin

Topics: Digitalis; Heart Failure

Topics: Adenine Nucleotides; Adenosine Triphosphate; Digitalis; Digitalis Glycosides; Electrolytes; Glutamates; Glutamic Acid; Heart Failure; Lanatosides

Topics: Digitalis; Digitoxin; Electrocardiography; Heart Failure; Plant Extracts

Topics: Digitalis; Digitoxin; Disease Management; Heart Failure; Humans; Plant Extracts

Topics: Acetyldigitoxins; Aged; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Patients; Plant Extracts

Topics: Ambulatory Care Facilities; Cardiac Glycosides; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

Topics: Cardiovascular Diseases; Digitalis; Heart Failure; Humans; Myocardial Infarction; Plant Extracts

Topics: Digitalis; Heart Failure; Humans; Strophanthidin; Strophanthins

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

Topics: Digitalis; Heart Failure; Humans; Plant Extracts

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Humans; Plant Extracts

Topics: Acetyldigitoxins; Cardiotonic Agents; Digitalis; Heart Failure; Plant Extracts

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

Topics: Chronic Disease; Digitalis; Heart Failure; Plant Extracts

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

Topics: Cardiovascular Agents; Digitalis; Heart Failure; Pyruvates; Pyruvic Acid; Thiamine Pyrophosphate

Topics: Digitalis; Erythrocytes; Heart Failure; Humans; Potassium

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

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides

Topics: Digitalis; Digitalis Glycosides; Electrolytes; Glutamates; Glutamic Acid; Heart Failure; Lanatosides

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

Topics: Cardiovascular Diseases; Child; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Infant; Nerium; Plant Extracts

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

Topics: Digitalis; Heart Failure; Humans; Plant Extracts

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

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

Topics: Barbiturates; Digitalis; Heart; Heart Failure; Humans

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts; Strophanthins

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

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

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

Topics: Acetyldigitoxins; Biomedical Research; Digitalis; Heart Failure

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Hemodynamics; Humans; Liver

Topics: Acetyldigitoxins; Cardiac Glycosides; Digitalis; Digitalis Glycosides; Heart; Heart Failure

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

Topics: Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digitalis; Heart Failure; Humans; Mitral Valve Stenosis

Topics: Digitalis; Heart Failure; Humans

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

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

Topics: Cardiotonic Agents; Diet; Digitalis; Diuretics; Heart Failure; Humans

Topics: Arrhythmias, Cardiac; Deslanoside; Digitalis; Digitalis Glycosides; Emergencies; Heart Failure; Humans; Myocardial Infarction

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

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

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides; Plants, Medicinal

Topics: Digitalis; Heart Failure; Myocardium

Topics: Body Fluids; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Plant Extracts; Urine

Topics: Blood; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Hemodynamics; Plant Extracts

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

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Humans

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

Topics: Anti-Arrhythmia Agents; Digitalis; Heart Failure; Plant Extracts

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides; Plant Extracts; Therapeutic Uses

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

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

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

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

Topics: Digitalis; Digitalis Glycosides; Electrolytes; Heart Failure; Kidney; Kidney Glomerulus; Strophanthins; Water

Topics: Aged; Anti-Arrhythmia Agents; Digitalis; Disease; Heart Failure; Humans

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

Topics: Cardiac Glycosides; Child; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Infant; Plant Extracts

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

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Glycosides; Heart Failure; Nerium

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Hypoproteinemia; Plasma

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

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

Topics: Blood; Digitalis; Digitoxin; Heart Failure; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Failure; Ornithogalum; Plants

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Hospitals, University; Plant Extracts

Topics: Aminophylline; Cardiotonic Agents; Child; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Infant

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Digoxin; Glycosides; Heart Failure; Humans

Topics: Acetyldigitoxins; Biomedical Research; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

Topics: Acetyldigitoxins; Cardiology; Digitalis; Digitalis Glycosides; Heart Failure; Medicine

Topics: Digitalis; Diuretics; Edema; Heart Failure; Humans; Organomercury Compounds; Pulmonary Embolism; Tachycardia; Thrombosis

Topics: Digitalis; Heart Failure; Humans; Lanatosides; Rheumatic Heart Disease; Therapeutics

Topics: Digitalis; Heart Failure; Humans; Lanatosides

Topics: Digitalis; Digoxin; Heart Failure; Humans

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

Topics: Child; Digitalis; Digitalis Glycosides; Heart Failure; Infant; Plant Extracts

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

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

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

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

Topics: Animals; Constriction; Digitalis; Digoxin; Dogs; Heart Failure; Pulmonary Artery; Pulmonary Circulation; Vascular Diseases

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

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Hemodynamics; Humans

Topics: Acetyldigitoxins; Biomedical Research; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

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

Topics: Aminophylline; Cardiotonic Agents; Coronary Circulation; Coronary Disease; Digitalis; Digitalis Glycosides; Heart Failure; Humans

Topics: Digitoxin; Heart Failure; Humans

Topics: Aged; Digitoxin; Disease; Heart Failure; Humans

Topics: Blood Pressure; Blood Pressure Determination; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Heart Ventricles; Venous Pressure

Topics: Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure

Topics: Diet; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans

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

Topics: Acetyldigitoxins; Digitalis; Heart Failure; Humans

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

Topics: Digitalis; Heart Failure; Humans

Topics: Digitalis; Heart Failure; Plant Extracts

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Potassium; Procainamide

Topics: Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Heart Conduction System; Heart Failure; Humans; Lanatosides

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

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

Topics: Digitalis; Digitalis Glycosides; Glucosides; Heart Failure; Humans; Plant Extracts

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

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

Topics: Digitalis; Heart Failure

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

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

Topics: Anti-Arrhythmia Agents; Digitalis; Heart Failure

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

Topics: Alkylmercury Compounds; Blood Coagulation; Digitalis; Drug Combinations; Heart Failure; Strophanthins; Theophylline

Topics: Blood Circulation; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

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

Topics: Digitalis; Electrokymography; Electromyography; Heart Failure; Heart Ventricles

Topics: Digitalis; Digitoxin; Heart Failure; Renal Elimination

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

Topics: Child; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Humans; Infant; Plant Extracts

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

Topics: Digitalis; Heart Failure; Plant Extracts

Topics: Digitalis; Heart Failure

Topics: Digitalis; Drug-Related Side Effects and Adverse Reactions; Heart Failure; Humans; Plant Extracts; Urticaria

Topics: Digitalis; Drug-Related Side Effects and Adverse Reactions; Gynecomastia; Heart Failure; Humans; Liver; Male; Plant Extracts

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

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

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides; Respiration; Tidal Volume

Topics: Diet; Digitalis; Digitalis Glycosides; Disease Management; Diuretics; Heart Failure; Humans; Hypnotics and Sedatives

Topics: Cardiovascular Agents; Digitalis; Heart Failure; Humans; Potassium

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts; Strophanthins; Thinking

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Organomercury Compounds; Plant Extracts

Topics: Digitalis; Heart Failure; Humans; Myocardium

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

Topics: Anti-Arrhythmia Agents; Digitalis; Heart Failure; Plant Extracts

Topics: Blood; Body Fluids; Digitalis; Digitalis Glycosides; Dithionite; Diuretics; Heart Failure; Kidney Function Tests; Organomercury Compounds; Sodium; Thiosulfates; Urine

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

Topics: Blood Coagulation; Blood Coagulation Tests; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Heparin; Humans; Prothrombin

Topics: Digitalis; Digitoxin; Heart Failure; Renal Elimination

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Follow-Up Studies; Heart Failure; Plant Extracts

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Myocardium; Plant Extracts

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

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

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

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Glycosides; Heart Failure

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

Topics: Digitalis; Electrolytes; Heart; Heart Failure; Water

Topics: Anti-Arrhythmia Agents; Biomedical Research; Digitalis; Digitalis Glycosides; Heart Failure

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

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

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

Topics: Digitoxin; Heart Failure; Humans

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Digitoxin; Heart Failure; Plant Extracts

Topics: Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Failure

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

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

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

Topics: Bradycardia; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Heart Rate; Humans; Mercury; Organomercury Compounds

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Failure; Hedera; Potassium

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

Topics: Anti-Arrhythmia Agents; Digitalis; Digitalis Glycosides; Heart Failure; Humans

Topics: Cardiac Glycosides; Digitalis; Glycosides; Heart; Heart Failure; Humans

Topics: Cardiac Catheterization; Digitalis; Digitalis Glycosides; Heart Failure; Hemodynamics; Humans

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

Topics: Cardiovascular System; Digitalis; Heart Failure; Humans; Kidney; Renal Circulation

Topics: Administration, Intravenous; Ballistocardiography; Digitalis; Digitalis Glycosides; Heart Failure

Topics: Cardiovascular System; Digitalis; Digoxin; Electrolytes; Heart Failure; Kidney

Topics: Digitalis; Digitalis Glycosides; Digoxin; Diuresis; Diuretics; Heart Failure; Leadership; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts; Strophanthins

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans

Topics: Digitalis; Digitalis Glycosides; Diuretics; Fluids and Secretions; Heart Failure; Humans; Mercury; Organomercury Compounds; Water-Electrolyte Balance

Topics: Blood Pressure; Blood Pressure Determination; Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Hedera; Hypertension; Ventricular Pressure

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Tuberculosis; Tuberculosis, Osteoarticular

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

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

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Physiological Phenomena; Plant Extracts

Topics: Chronic Disease; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Plant Extracts

Topics: Diet; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Water

Topics: Blood; Blood Coagulation; Digitalis; Digitalis Glycosides; Heart Failure; Humans

Topics: Cardiovascular System; Digitalis; Digitalis Glycosides; Diuresis; Diuretics; Heart; Heart Failure; Humans

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Heart; Heart Failure; Humans; Plant Extracts

Topics: Blood Pressure; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Diuresis; Diuretics; Heart Failure; Humans; Theophylline; Venous Pressure

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

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Humans; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure; Plant Extracts; Potassium; Potassium Chloride

Topics: Cardiovascular System; Digitalis; Digitalis Glycosides; Digoxin; Heart; Heart Failure

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

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure

Topics: Anti-Bacterial Agents; Digitalis; Digitalis Glycosides; Heart Failure; Lanatosides; Plant Extracts

Topics: Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Disease Management; Heart Failure; Humans; Lanatosides

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Humans; Recurrence

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

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

Topics: Chronic Disease; Digitalis; Heart Failure; Humans; Lung Diseases; Oxygen; Phlebotomy; Plant Extracts

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

Topics: Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Plant Extracts

Topics: Digitalis; Heart Failure; Humans; Lanatosides

Topics: Blood Pressure; Digitalis; Digitalis Glycosides; Heart; Heart Failure; Humans; Strophanthins; Venous Pressure

Topics: Digitalis; Digitalis Glycosides; Heart; Heart Failure; Humans; Recurrence

Topics: Administration, Intravenous; Digitalis; Digitalis Glycosides; Heart; Heart Failure; Hospitalization; Humans; Lanatosides; Pharmaceutical Preparations