digoxin and Acute-Disease

The pharmacologic management of acute heart failure syndromes (AHFS) has changed little over the past 15 years. Traditional therapies, such as nitrates and loop diuretics, remain the mainstay of therapy, with inotropes reserved for patients who present in shock or an advanced low-output state. We review the use of these therapies in AHFS with added insights from recent clinical trials and registry data.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Milrinone; Mineralocorticoid Receptor Antagonists; Morphine; Nitroprusside; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Survival Analysis; Syndrome; Treatment Outcome

Digitalis preparations have been used for centuries. Digoxin is an agent that is readily available, can be administered acutely and long-term, intravenously or orally, is safe and may be beneficial in both acute and chronic heart failure (HF). It may be an ideal drug for the treatment of acute heart failure syndromes and warrants further investigation in large clinical trials. The role of digoxin in acute and chronic HF was discussed at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This report represents a summary of the presentation at this meeting.

Topics: Acute Disease; Cardiotonic Agents; Digoxin; Heart Failure; Humans; Stroke Volume; Treatment Outcome

Treatment with inotropic agents is one of the most controversial topics in heart failure. Initial enthusiasm, based on strong pathophysiological rationale and apparent empirical efficacy, has been progressively limited by results of controlled trials and registries showing poorer outcomes of the patients on inotropic therapy. The use of these agents remains, however, potentially indicated in a significant proportion of patients with low cardiac output, peripheral hypoperfusion and end-organ dysfunction caused by heart failure. Limitations of inotropic therapy seem to be mainly related to their mechanisms of action entailing arrhythmogenesis, peripheral vasodilation, myocardial ischemia and damage, and possibly due to their use in patients without a clear indication, rather than to the general principle of inotropic therapy itself. This review will discuss the characteristics of the patients with a potential indication for inotropic therapy, the main data from registries and controlled trials, the mechanism of the untoward effects of these agents on outcomes and, lastly, perspectives with new agents with novel mechanisms of action.

Topics: Acute Disease; Cardiotonic Agents; Digoxin; Dobutamine; Etiocholanolone; Exercise Test; Heart Failure; Hemodynamics; Hospitals, Group Practice; Humans; Hydrazones; Prognosis; Pyrazines; Pyridazines; Quinolines; Sarcoplasmic Reticulum Calcium-Transporting ATPases; Simendan; Treatment Outcome; Urea; Vasodilator Agents

Congestive heart failure (CHF) is an increasingly common medical condition and the fastest growing cardiovascular diagnosis in North America. Over one-third of patients with heart failure also have renal insufficiency. It has been shown that renal insufficiency confers worsened outcomes to patients with heart failure. However, a majority of the larger and therapy-defining heart failure medication and device trials exclude patients with advanced renal dysfunction. These studies also infrequently perform subgroup analyses based on the degree of renal dysfunction. The lack of information on heart failure patients who have renal insufficiency likely contributes to their being prescribed mortality and morbidity reducing medications and receiving diagnostic and therapeutic procedures at lower rates than heart failure patients with normal renal function. Inclusion of patients with renal insufficiency in heart failure studies and published guidelines for medication, device, and interventional therapies would likely improve patient outcomes.

Topics: Acute Disease; Adrenergic beta-Antagonists; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Cardiac Catheterization; Cardiac Pacing, Artificial; Clinical Trials as Topic; Digoxin; Heart Failure; Humans; Milrinone; Mineralocorticoid Receptor Antagonists; Natriuretic Peptide, Brain; Renal Insufficiency, Chronic; Treatment Outcome; Ultrafiltration

Several treatment strategies exist for patients hospitalized with acute heart failure syndromes (AHFS). These therapies traditionally focus on improving hemodynamics and relieving congestion. This review focuses on noninodilator therapies, including diuretics, nitrovasodilators (nitroprusside and nitroglycerin), vasodilators (nesiritide), digoxin, and intravenous angiotensin-converting enzyme inhibitors. These agents are used based on their associated symptomatic improvements alone. In the hospitalized setting, none of these agents have demonstrated benefits on long-term outcomes. Future work in AHFS should strive to understand the influence of conventional and new pharmacologic therapies on the underlying pathophysiology of AHFS, the processes that lead to myocardial injury and progressive heart failure, and measurable clinical outcomes.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Digoxin; Diuretics; Heart Failure; Humans; Natriuretic Peptide, Brain; Nitroglycerin; Nitroprusside; Severity of Illness Index; Syndrome; Vasodilator Agents

Topics: Acute Disease; Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Bisoprolol; Cardiotonic Agents; Clinical Trials as Topic; Digoxin; Electric Countershock; Heart Failure; Humans; Quinidine; Randomized Controlled Trials as Topic; Sotalol; Sympatholytics; Time Factors; Vasodilator Agents

Topics: Acute Disease; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Diltiazem; Electrocardiography; Fibrinolytic Agents; Humans; Prognosis; Randomized Controlled Trials as Topic; Thromboembolism; Timolol; Treatment Outcome; Verapamil

In our environment, the use of Fab antibodies for digoxin intoxication is often difficult due to the low availability of this drug in most centers. We present a case of massive digoxin intoxication that was successfully managed with the classic treatment. Later, we discuss the need to individualize the management of this kind of intoxications in order to reduce, when possible, sanitary costs.

Topics: Acute Disease; Aged; Anti-Arrhythmia Agents; Combined Modality Therapy; Digoxin; Female; Humans; Immunoglobulin Fab Fragments; Poisoning; Suicide, Attempted

To systematically review the management of atrial fibrillation (AF) in patients with heart failure.. Studies investigating the management of AF in patients with heart failure published between 1967 to 1998 were identified using MEDLINE, the Cochrane register and Embase databases. Reference lists from relevant papers and reviews were hand searched for further papers.. Eight studies pertaining to acute and twenty-four pertaining to chronic AF were identified. For patients with acute AF ventricular rate control, anticoagulation and treatment of heart failure should be pursued simultaneously before cardioversion is attempted. Digoxin is relatively ineffective at controlling ventricular response and for cardioversion. Intravenous diltiazem is rapidly effective in controlling ventricular rate and limited evidence suggests it is safe. Amiodarone controls ventricular rate rapidly and increases the rate of cardioversion. There are insufficient data to conclude that immediate anti-coagulation, trans-oesophageal echocardiography to exclude atrial thrombi followed by immediate cardioversion is an appropriate strategy. Patients with chronic AF should be anti-coagulated unless contra-indications exist. It is not clear whether the preferred strategy should be cardioversion and maintenance of sinus rhythm with amiodarone or ventricular rate control of AF combined with anticoagulation to improve outcome including symptoms, morbidity and survival. Electrical cardioversion has a high initial success rate but there is also a high risk of early relapse. Amiodarone currently appears the most effective and safest therapy for maintaining sinus rhythm post-cardioversion. Digoxin is fairly ineffective at controlling ventricular rate during exercise. Addition of a beta-blocker reduces ventricular rate and improves symptoms. Whether digoxin is required in addition to beta-blockade for the control of AF in this setting is currently under investigation. If pharmacological therapy is ineffective or not tolerated then atrio-ventricular node ablation and permanent pacemaker implantation should be considered.. There is a paucity of controlled clinical trial data for the management of AF among patients with heart failure. The interaction between AF and heart failure means that neither can be treated optimally without treating both. Presently treatment should be on a case by case basis.

Topics: Acute Disease; Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Chronic Disease; Clinical Trials as Topic; Digoxin; Diltiazem; Electric Countershock; Heart Failure; Humans; Retrospective Studies

Although most acute pediatric ingestions of digoxin or other related cardiac glycosides result in minimal or no symptoms, occasionally a child is symptomatic. Gastrointestinal complaints or first-degree AV block are the most common presenting symptoms. Children can generally be given a single dose of activated charcoal, observed, and discharged without any subsequent problems. However, some patients will be toxic and require monitoring, medication, and possibly digoxin-specific antibody fragments. The most important role of the clinician is to recognize the clinical manifestations and institute the appropriate therapy. As in the case presented, the history of an ingestion may not always be obtained initially. Thus, the physician should maintain a high index of suspicion for acute digoxin ingestion and order the appropriate confirmatory tests (eg, a digoxin level, a potassium level, and a 12-lead ECG) when necessary.

Topics: Acute Disease; Cardiotonic Agents; Digitalis; Digoxin; Humans; Infant; Male; Plants, Medicinal; Plants, Toxic; Poisoning; United States

Atrial fibrillation (AF) encompasses a variety of discrete clinical syndromes, including paroxysmal, chronic, acute, and postoperative. Digoxin, long considered the mainstay of therapy for rate control in all types of AF, appears to have only modest electrophysiologic effects, which are mediated primarily by the autonomic nervous system. Digoxin has less potency than the calcium antagonists or beta-blocking drugs with respect to atrioventricular nodal blockade. Although less potent than calcium antagonists or beta-blocking drugs on the atrioventricular node, digoxin provides positive inotropic support, whereas the other 2 agents can suppress left ventricular function. Thus, digoxin is the agent of choice in patients with AF in the setting of significant left ventricular dysfunction. However, in the absence of left ventricular dysfunction, digoxin should be considered second-line therapy for the treatment of all AF syndromes.

Topics: Acute Disease; Adrenergic beta-Antagonists; Atrial Fibrillation; Calcium Channel Blockers; Chronic Disease; Contraindications; Digoxin; Drug Therapy, Combination; Electrophysiology; Humans; Infant, Newborn; Premedication

The history of the discovery of endogenous digoxin-like factor (EDF) is described and the role played by the substance in blood circulation regulation, in the pathogenesis of arterial hypertension is discussed. The authors provide their own data (both experimental and clinical ones) concerned with EDF participation in the pathogenesis of early ventricular fibrillations in acute myocardial ischemia. Experiments on rats demonstrated that myocardial infarction (MI) is marked by a negative linear correlation between the intensity of ventricular fibrillations and the activity of Na,K-ATPase of intact red blood cells (r = -0.84) that mirrors the content of circulating EDF. Administration to the animals of digoxin antibodies binding EDF resulted in the antiarrhythmic effect and in the recovery of the enzyme activity. The patients demonstrated, within the first day of MI, a 76-percent inhibition of the activity of Na,K-ATPase of red blood cells. A correlation was discovered between the enzyme activity and the capacity of protein-free supernatants of blood plasma for inhibiting Na,K-ATPase, which indicates the presence of circulating EDF in blood plasma.

Topics: Acute Disease; Animals; Arrhythmias, Cardiac; Blood Circulation; Blood Proteins; Cardenolides; Coronary Disease; Digoxin; Female; Humans; Male; Middle Aged; Ouabain; Rats; Rats, Inbred Strains; Saponins; Sodium-Potassium-Exchanging ATPase

Topics: Acute Disease; Blood Pressure; Cardiac Complexes, Premature; Cardiotonic Agents; Chronic Disease; Digoxin; Diuretics; Dobutamine; Heart Failure; Hemodynamics; Humans; Isoproterenol; Myocardial Infarction

Acute digoxin poisoning, its recognition and management, are reviewed. The uses of syrup of ipecac, gastric lavage, activated charcoal, cholestyramine, colestipol, edetate sodium and cathartics as measures to terminate the drug exposure are discussed. Measures to hasten digoxin elimination, such as the use of furosemide, hemodialysis and digoxin-specific antibodies are reviewed. Supportive management may include treatment with atropine, phenytoin, lidocaine, propranolol, glucose, insulin and sodium polystyrene sulfonate. Proper management of digoxin poisoning involves the use of standard decontamination procedures (emesis or gastric lavage). Activated charcoal is strongly recommended, followed by rapidly acting cathartics. Antiarrhythmic therapy usually involves atropine sulfate and phenytoin sodium.

Topics: Acute Disease; Adolescent; Adult; Aged; Child, Preschool; Digoxin; Drug Therapy; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged

Topics: Acute Disease; Digoxin; Diuretics; Heart; Hemodynamics; Humans; Hyaluronoglucosaminidase; Methylprednisolone; Myocardial Infarction; Propranolol; Vasodilator Agents

Topics: Acute Disease; Cardiac Catheterization; Cardiomegaly; Child; Child, Preschool; Chronic Disease; Cystic Fibrosis; Digoxin; Electrocardiography; Female; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Lung; Male; Pulmonary Heart Disease; Radiography; Vectorcardiography

Topics: Acute Disease; Aminophylline; Assisted Circulation; Cardiac Glycosides; Digoxin; Diuretics; Electric Countershock; Heart; Heart Diseases; Heart Failure; Humans; Morphine; Ouabain; Oxygen Inhalation Therapy; Phentolamine; Pulmonary Edema; Tachycardia; Vasodilator Agents

Variability in the response to drugs is due to three principal components-the disease, the responsiveness of tissues, and the concentration of the drug at its site of action (as reflected by its plasma concentration). The relative contributions of these components will differ not only for different drugs but also for different effects of the same drug. Rational drug therapy depends on knowledge of all three factors.

Topics: Acute Disease; Acylation; Chlorthalidone; Chronic Disease; Depression; Diazoxide; Digoxin; Dose-Response Relationship, Drug; Glomerulonephritis; Humans; Hypertension; Nephrotic Syndrome; Norepinephrine; Nortriptyline; Oxidation-Reduction; Phenylthiourea; Serotonin; Spironolactone; Steroids

The aim of the present study was to compare the safety and efficacy of amiodarone and procainamide in the acute cardiology setting.. The study population consisted of 223 patients with symptomatic atrial fibrillation (AF). After administration of digoxin for ventricular rate control, all patients who failed to restore sinus rhythm (SR) were randomized into 2 groups: group A (113 patients) were administered 300 mg amiodarone intravenously over 30 min and, in case of failure to restore SR, amiodarone of 20 mg/kg/24 h was administered intravenously. Group B (110 patients) were intravenously administered a bolus dose of 1 gm procainamide, at an infusion rate 50/mg/min, and, in case of failure to restore SR, 2 mg/min for the next 24 h.. The rate of cardioversion to SR was similar between amiodarone (81.4%) and procainamide (82.7%) (P=NS). Procainamide loading recorded faster cardioversion times than amiodarone loading (P=0.02), but there was no significant difference after that. Amiodarone caused a significant decrease on systolic blood pressure compared to procainamide for the first 18 h (P<0.001), and a significant decrease in the diastolic blood pressure for the first 6 h (P<0.001). Side-effects for either medication were sparse. The only real prognostic factor for successful cardioversion remains the size of left atrium.. Both drugs were equally effective in restoring SR, though procainamide acts quicker in the loading phase. Both medications are safe and side effects develop only in the maintenance phase.

Topics: Acute Disease; Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Blood Pressure; Digoxin; Drug Therapy, Combination; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Procainamide; Time Factors; Treatment Outcome

Atrial fibrillation is commonly treated with intravenously administered digoxin. The main objective of this study was to investigate the relationship between plasma concentration of digoxin and heart rate.. Plasma concentrations of digoxin were analysed in 105 patients allocated to digoxin therapy in the Digitalis in Acute Atrial Fibrillation (DAAF) trial. A pharmacokinetic/pharmacodynamic (PK/PD) model for the relationship among digoxin dose, plasma concentration and heart rate in patients remaining in atrial fibrillation was constructed using non-linear, mixed-effect modelling. One hundred and twenty-two placebo-treated patients were included as a control group. In 56 patients, one late sample at 16 h after the first dose of digoxin was obtained while in 49 patients an early sample at 0.25-0.5 h and a late sample 16 h after the first dose were obtained. Heart rate was measured at 0, 2, 6, 12 and 16 h after inclusion, with data from 98, 89, 67, 56 and 53 patients available at each time point, respectively.. A two-compartment model best described the time course of digoxin concentrations in plasma. Digoxin and creatinine clearance correlated strongly and mean plasma concentration of digoxin at 16 h was within recommended levels (1.6+/-1.0 nM). The decrease in heart rate in placebo-treated patients was, on average, 0.5 beats/min (bpm) per hour. In patients on digoxin, a linear relationship between the estimated digoxin concentration at the effect site and the drop-in heart rate was found. The half-life for the digoxin distribution to the effect compartment was approximately 3.8 h. The degree of reduction was related to the initial heart rate and patients with higher heart rate had a more pronounced decrease. The model predicted that a digoxin concentration of 1 nM at the effect site reduces heart rate by 9.4%.. A PK/PD model for the relationship between the plasma concentration of digoxin, the estimated concentration at the effect site and the reduction in heart rate during atrial fibrillation could be defined using a population pharmacokinetic approach. Our data indicate that a more aggressive dosing regimen of digoxin may be more effective in terms of heart rate reduction.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Dose-Response Relationship, Drug; Double-Blind Method; Electrocardiography; Half-Life; Heart Rate; Humans; Injections, Intravenous; Linear Models; Middle Aged; Time Factors

The isoprenoid pathway produces three key metabolites--digoxin (membrane Na+-K+ ATPase inhibitor, regulator of neurotransmitter transport, and an immunomodulatory agent), dolichol (a regulator of N-glycosylation of proteins), and ubiquinone (a free radical scavenger). The pathway was assessed in acute rheumatic fever patients with recurrent streptococcal infections, and who were also studied for differences in right and left hemispheric dominance. The isoprenoid pathway was downregulated with decreased digoxin synthesis in these patients and in those with left hemispheric chemical dominance. The tryptophan catabolites were decreased and the tyrosine catabolites increased. In these groups of patients the dolichol and glycoconjugate levels were reduced and lysosomal stability was increased. The ubiquinone levels were elevated and free radical levels decreased in these patients. The membrane cholesterol:phospholipid ratios were decreased and membrane glycoconjugates increased. On the other hand in right hemispheric chemical dominance the reverse patterns and hyperdigoxinemia with an upregulated isoprenoid pathway were noticed. The role of the isoprenoid pathway in the pathogenesis of acute rheumatic fever and recurrent streptococcal infections and its relation to hemispheric chemical dominance is discussed.

Topics: Acute Disease; Adolescent; Analysis of Variance; Child; Digoxin; Disease Susceptibility; Dolichols; Dominance, Cerebral; Down-Regulation; Enzyme Inhibitors; Erythrocyte Membrane; Glycoproteins; Glycosaminoglycans; Humans; Hydroxymethylglutaryl CoA Reductases; Immunologic Deficiency Syndromes; Magnesium; Matched-Pair Analysis; Neuroimmunomodulation; Neurotransmitter Agents; Pharyngitis; Polyisoprenyl Phosphates; Recurrence; Rheumatic Fever; Sodium-Potassium-Exchanging ATPase; Streptococcal Infections; Ubiquinone

The role of digoxin and verapamil in the control of ventricular response in rapid atrial fibrillation is well established. This study investigates how clonidine compares with these standard therapies in rate control for new-onset rapid atrial fibrillation. We set out to test the hypothesis that clonidine effectively reduces heart rate in patients with new-onset rapid atrial fibrillation.. Forty patients were seen in the emergency department with new-onset (< or =24 hours' duration), stable, rapid atrial fibrillation. Eligible patients were randomized to receive either clonidine, digoxin, or verapamil. Changes in heart rate and blood pressure over 6 hours, as well as frequency of conversion to sinus rhythm were recorded and analyzed.. The mean reduction in heart rate over 6 hours was 44.4 beats/min (95% confidence interval [CI] 28.4-60.4 beats/min) in the clonidine group, 52.1 beats/min (95% CI 40.8-63.4 beats/min) in the digoxin group, and 41.8 beats/min (95% CI 22.5-61.0 beats/min) in the verapamil group. Analysis of variance of the heart rate changes in the 3 groups after 6 hours was not significant (P =.55). At 6 hours, 7 of 12 clonidine patients, 8 of 15 digoxin patients, and 7 of 13 verapamil patients remained in atrial fibrillation (P =.962 on chi(2)).. Clonidine controls ventricular rate in new-onset atrial fibrillation with an efficacy comparable to that of standard agents.

Topics: Acute Disease; Administration, Oral; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Blood Pressure; Clonidine; Digoxin; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Prospective Studies; Treatment Outcome; Verapamil

Studies of healthy volunteers or patients in sinus rhythm have indicated that treatment with digoxin produces characteristic changes in the electrocardiogram (ECG). No randomized, placebo-controlled studies are available and no study has investigated the effect on ECG in patients with atrial fibrillation.. In a substudy to a trial comparing the therapeutic effect of intravenously administered digoxin with placebo in patients with acute atrial fibrillation, we investigated these effects as well as the relation between ECG changes and serum concentration of digoxin.. In all, 167 patients were included. Standard ECGs recorded at baseline, and at 2, 6, 12, and 16 h after randomization were digitized, and changes in RR-intervals, QRS width, ST-segment amplitude at 60 ms after the J point, T-wave amplitude, and QTc interval were calculated. Furthermore, the correlation between the serum concentration of digoxin at 16 h after inclusion and changes on the ECG was analyzed.. Compared with placebo, digoxin resulted in an increase in RR-interval (p < 0.0001), a decrease in ST-segment and T-wave amplitude (p = 0.009 and p = 0.002, respectively), and in the QTc interval (p = 0.01). These changes were present 2 h after the first dose, but were more pronounced after 16 h. There was no significant correlation between serum concentration of digoxin and ECG changes at 16 h.. Compared with placebo, digoxin produces significant changes on ECG in patients with acute atrial fibrillation. The changes are in accordance with previous findings in individuals in sinus rhythm. There was no correlation between serum concentration of digoxin and ECG changes.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Electrocardiography; Female; Follow-Up Studies; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Prospective Studies; Signal Processing, Computer-Assisted; Treatment Outcome

Atrial filling pressures are increased in acute atrial fibrillation, which stimulates the release of atrial natriuretic factor pro-hormone, proANF.. In a randomized trial comparing digoxin with placebo in 216 patients, we investigated whether the baseline plasma level of N-terminal proANF is a predictor for conversion to sinus rhythm and the relation among N-terminal proANF, conversion to sinus rhythm, and changes in heart rate.. N-terminal proANF was increased at baseline and decreased significantly in patients converting to sinus rhythm, whereas it was mainly unchanged in nonconverters. N-terminal proANF was not a predictor of conversion to sinus rhythm. A relation was found between relative changes in heart rate and N-terminal proANF in nonconverters.. The level of N-terminal proANF does not predict conversion to sinus rhythm, which indicates that hemodynamics per se is not important. There is a correlation between relative changes in heart rate and N-terminal proANF in nonconverters.

Topics: Acute Disease; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Biomarkers; Digoxin; Heart Rate; Humans; Natriuresis; Protein Precursors

In recent-onset atrial fibrillation, intravenous propafenone has been shown to effectively restore sinus rhythm, whereas the efficacy of intravenous digoxin has been questioned. We directly compared these 2 drugs and placebo in acute atrial fibrillation. One hundred twenty-three patients with atrial fibrillation lasting <72 hours were randomized to a 10-minute intravenous infusion of either propafenone (2 mg/kg, 41 patients) or digoxin (0.007 mg/kg, 40 patients) or placebo (42 patients). After 1 hour, nonconverted propafenone or digoxin patients were switched to the alternative drug, while nonconverted placebo patients were randomized to either propafenone or digoxin. The observation time ended 1 hour later. By 1 hour, conversion rates were 49% in the propafenone group, 32% in the digoxin group (p = 0.12), and 14% in placebo group (p <0.001 vs propafenone, p = 0.08 vs digoxin). After crossover, digoxin converted 5% of propafenone patients, while propafenone converted 48% of digoxin patients (p <0.05). In the 36 nonconverted placebo patients, sinus rhythm was obtained in 53% of cases with propafenone, and in 5% with digoxin (p < 0.05). Globally, among the 116 patients who received a drug as first treatment, 30 of 60 patients (50%) were converted by propafenone versus 14 of 56 (25%) by digoxin (p <0.01) (odds ratio 2.0, 95% confidence interval 1.19 to 3.36). In nonconverters, the ventricular rate reduction was faster (15 vs 45 minutes) and more prominent (-24% vs -14%) with propafenone than with digoxin. In conclusion, intravenous propafenone terminates atrial fibrillation more effectively than either placebo or intravenous digoxin. In addition, in nonconverted patients, it obtains a more rapid and marked control of the ventricular rate.

Topics: Acute Disease; Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Propafenone; Single-Blind Method; Treatment Outcome

To compare the effects of i.v. diltiazem and i.v. digoxin on ventricular rate control in the emergency treatment of acute atrial fibrillation and flutter (AFF).. This prospective, randomized, open-label trial involved 30 consecutive patients who presented with acute AFF to the emergency department of an urban, 420-bed community teaching hospital from April 1993 through March 1994. Exclusion criteria included systolic blood pressure lower than 100 mm Hg, treatment with calcium-channel blockers other than diltiazem, lack of informed consent, and objection of the private physician. Patients were randomly assigned to receive either i.v. diltiazem alone, i.v. digoxin alone, or both. Heart rate control was defined as a ventricular rate of less than 100 beats/minute. I.v. digoxin, 25 mg, was given as a bolus at time 0 and at time 30 minutes. An initial dose of .25 mg/kg diltiazem was given intravenously over the first 2 minutes, followed by a dose of .35 mg/kg at time 15 minutes and then a titratable i.v. infusion at a rate of 10 to 20 mg/hour to maintain heart rate control. The dosing regimens were the same whether the drugs were given alone or in combination. Heart rhythm, heart rate, and blood pressure were measured at time 0, 5, 10, 15, 30, 60, 120, and 180 minutes. Statistical significance was assessed with the use of Student's t test and ANOVA methodology.. At time 0, the heart rate (mean +/- SD) was 150 +/- 19 beats/minute in the diltiazem group and 144 +/- 12 in the digoxin group (difference not significant, P = .432). The decrease in heart rate from time 0 reached statistical significance at time 5 minutes in the diltiazem group (P = .0006); the mean rates at time 5 minutes were 111 +/- 26 beats/minute for diltiazem and 144 +/- 13 for digoxin. The decrease in heart rate achieved with digoxin did not reach statistical significance until time 180 minutes (P = .0099), at which time the rates were 90 +/- 13 for diltiazem and 117 +/- 22 for digoxin.. Treatment of acute AFF with i.v. diltiazem decreases ventricular heart rate significantly within 5 minutes, compared with 3 hours for treatment with i.v. digoxin. No advantage was noted within 3 hours for i.v. treatment with a combination of diltiazem and digoxin. I.v. diltiazem is superior to i.v. digoxin in the emergency control of ventricular rate in acute AFF and should be considered as a drug of choice for this condition. This study was not large enough to adequately assess adverse effects, and further studies may be warranted for clinical validation.

Topics: Acute Disease; Aged; Aged, 80 and over; Analysis of Variance; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Digoxin; Diltiazem; Emergency Medical Services; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Prospective Studies; Treatment Outcome

The DAAF Trial was designed to investigate whether digoxin, within 16 h of its use, increases the rate of conversion to sinus rhythm in patients with acute atrial fibrillation.. In a randomized, double-blind multicentre trial the effects of intravenous digoxin and placebo, (mean dose 0.88 +/- 0.35 mg and 0.96 +/- 0.37 mg) were compared in 239 patients with a mean age of 66.2 +/- 13.0 years and atrial fibrillation of, at most, 7 days' duration. The mean arrhythmia duration was 21.7 +/- 30.4 h and baseline heart rate 122.0 +/- 23.0 beats.min-1. At 16 h, 46% of the placebo group and 51% of the digoxin group had converted to sinus rhythm, (ns). Time to sinus rhythm was shorter in the digoxin group, but the difference was not significant. Digoxin had a pronounced and rapid effect on heart rate, which was already significant at 2 h; 104.6 +/- 20.9 beats.min-1 vs 116.8 +/- 22.5 beats.min-1 (P = 0.0001).. Acute intravenous treatment with digoxin does not increase the rate of conversion to sinus rhythm, but has a fast acting and clinically significant effect on heart rate and should remain an alternative in haemodynamically stable patients.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Dose-Response Relationship, Drug; Double-Blind Method; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Sweden

We randomized 61 patients with paroxysmal atrial fibrillation (AF) ( < 48 hours from onset) to either sotalol or quinidine treatment. Conversion of rhythm was recorded by Holter monitoring. The starting 80 mg dose of sotalol was repeated at 2, 6, and 10 hours if AF persisted (heart rate > 80 beats/min), and if systolic blood was > or = 120 mm Hg. In the quinidine group, if heart rate > 100 beats/min, it was decreased with intravenous digoxin, whereafter 200 mg of oral quinidine sulfate was given maximally 3 times, each dose 2 hours apart. Conversion of AF to sinus rhythm occurred in 17 or 33 patients (52%) taking sotalol, and in 24 of 28 patients (86%) taking quinidine (p < 0.0001). Electric cardioversion was necessary in 39% of the former and in 14% of the latter group. The mean delay from first trial drug to sinus rhythm with the trial medication was 10.2 +/- 7.6 hours in the sotalol group and 4.0 +/- 2.9 hours in the quinidine group (p < 0.01). Treatment was discontinued in 16 patients taking sotalol (48%) because of asymptomatic bradycardia or hypotension, and in 20 taking quinidine (71%) because of rhythm conversion. Asymptomatic wide complex tachycardia (QRS > 0.12 second) was found in 13% and 27% of patients taking sotalol and quinidine, respectively. The longest RR intervals were 6.4 and 3.8 seconds in the sotalol and quinidine groups, respectively. Oral sotalol did not appear as effective as quinidine sulfate treatment in conversion of paroxysmal AF.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adult; Aged; Atrial Fibrillation; Digoxin; Drug Therapy, Combination; Female; Heart Rate; Humans; Male; Middle Aged; Quinidine; Sotalol; Tachycardia; Time Factors

Controversy surrounds the safety of digoxin use in patients recovering from acute myocardial infarction. Previous observations yielded contradictory conclusions. To determine whether digoxin therapy is associated with increased mortality in patients recovering from acute myocardial infarction, we analyzed data from 1731 survivors of acute myocardial infarction enrolled in the Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT), from which patients with severe heart failure were excluded. At the time of hospital discharge, 175 patients (10%) were taking digoxin. Mortality over 1 year after infarction was significantly higher in patients treated with digoxin than in patients who were not receiving digoxin [27 of 175 (15%) vs. 60 of 1556 (4%); p < 0.0001]. Digoxin administration was associated with increased mortality in several subsets of patients. Since patients treated with digoxin had baseline characteristics predictive of mortality more frequently than their counterparts, we adjusted for these differences. Multivariate analysis performed by the Cox proportional hazards model identified treatment with digoxin as an independent determinant associated with increased death during the first year after myocardial infarction [relative risk (RR) 2.8; 90% confidence interval (CI) 1.8-4.2]. Subgroup multivariate analysis indicated digoxin as an independent predictor of first year death in 464 patients who developed heart failure during their hospital stay (RR 2.3; 90% CI 1.3-4.0), as well as among 1267 patients who did not (RR 3.4; 90% CI 1.7-6.9). The present study suggests a significant excess mortality associated with digoxin therapy after myocardial infarction. The increased mortality risk may be related to unidentified variables associated with the severity of disease in patients treated with digoxin. However, our findings raise concern that the administration of digoxin may contribute to increased mortality in survivors of acute myocardial infarction.

Topics: Acute Disease; Adrenergic beta-Antagonists; Aged; Arrhythmias, Cardiac; Cardiotonic Agents; Digoxin; Double-Blind Method; Electrocardiography, Ambulatory; Female; Humans; Israel; Male; Middle Aged; Myocardial Infarction; Regression Analysis; Risk; Survivors

The efficacy and safety of intravenous flecainide to convert recent-onset atrial fibrillation (AF) (present for greater than or equal to 30 minutes and less than or equal to 72 hours and a ventricular response greater than or equal to 120 beats/min) was investigated. A total of 102 patients without severe heart or circulatory failure were randomized to receive either intravenous flecainide (2 mg/kg, maximum dose 150 mg; 51 patients) or placebo (51 patients) in a double-blind trial. Digoxin (500 micrograms intravenously) was administered to all patients who had not previously been receiving digoxin. The electrocardiogram was monitored continuously during the study. In 29 (57%) patients stable sinus rhythm was restored within 1 hour after flecainide and in only 7 (14%) given placebo (chi square 18.9; p = 0.000013; odds ratio 8.3; 95% confidence interval 2.9-24.8). Reversion to sinus rhythm within 1 hour after starting the trial medication was considered a pretrial end point and likely to be due to a drug effect. At the end of the 6-hour monitoring period, 34 patients (67%) in the flecainide group were in sinus rhythm whereas only 18 (35%) in the placebo group had reverted (chi square 8.83, p = 0.003; odds ratio 3.67; 95% confidence interval 1.5-9.1). Significant hypotension, although short lived, was more common in the flecainide group. One patient given flecainide developed torsades de pointes and was successfully electrically cardioverted. Flecainide is useful for the management of recent-onset AF both for control of the ventricular response and conversion to sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Double-Blind Method; Drug Evaluation; Female; Flecainide; Humans; Hypotension; Male; Middle Aged; Monitoring, Physiologic; Time Factors

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

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

Fifty six adult patients were randomised to treatment with flecainide (group 1, n = 29) or a combination of digoxin and disopyramide (group 2, n = 27) for acute atrial fibrillation and flutter after cardiac surgery. Intravenous flecainide was given as a 2 mg/kg bolus over 20 minutes followed by an infusion (0.2 mg/kg per hour) for 12 hours. Group 2 were given digoxin (0.75 mg) intravenously followed two hours later by an intravenous bolus of disopyramide (2 mg/kg) and an infusion (0.4 mg/kg per hour) for 10 hours. Within 12 hours sinus rhythm was restored in 86% of the group 1 (25 patients) and 89% of the group 2 (24 patients). The median time to reversion was significantly shorter in group 1 (80 minutes, range 30-180 minutes) than group 2 (220 minutes, range 138-523 minutes). None of the patients in group 1 and four of the patients in group 2 had transient relapses into atrial fibrillation during the 12 hours of intravenous treatment. There were five late relapses in group 1 and seven in group 2 during subsequent oral treatment. Two group 1 patients and two group 2 patients showed adverse drug effects. Intractable ventricular arrhythmias occurred after five days of oral treatment in one patient (group 1) who had poor left ventricular function, hepatic impairment, and toxic concentrations of drugs at the time of death. Flecainide was as effective as the combination of digoxin and disopyramide and it acted significantly faster and was associated with fewer relapses. Monitoring of blood concentrations of flecainide is essential in patients with poor left ventricular function and hepatic impairment.

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Clinical Trials as Topic; Digoxin; Disopyramide; Drug Therapy, Combination; Female; Flecainide; Humans; Male; Middle Aged; Postoperative Complications; Random Allocation

Topics: Acute Disease; Clinical Trials as Topic; Coronary Disease; Digoxin; Drug Evaluation; Hemodynamics; Humans; Lanatosides; Mitral Valve Stenosis; Postoperative Period; Rheumatic Heart Disease; Strophanthins

Patients with acute myocardial infarction were allocated to two groups according to a double blind-system of radomization. The patients (n = 18) in one of the groups received digoxin intravenously as an injection of 0.01 mg. per kilogram of body weight during 10 minutes. The patients in the other group (n = 15) received saline and served as controls. A continuous ECG record was obtained from each patient during 1 hour preceding the administration of digoxin or saline and was continued for 3 hours following the injection. No antiarrhythmic treatment was given during the time of the study. Based on the continuous ECG, calculations were made of the relative incidence of patients with different types of ventricular tachyarrhythmias during the period of observation as well as the percentage of arrhythmia-containing 1 minute intervals observed during this period. There was no statistical difference between the incidence of ventricular tachyarrhythmias in the two groups in the 1 hour period preceding drug injection. The administration of digoxin and saline did not change the incidence of ventricular tachyarrhythmias and there was also no statistically significant difference between the two groups as regards the incidence of patients showing different types of ventricular tachyarrhythmias during the 3 hour period following drug administration, Considering the 1-minute intervals, those without any ventricular premature contractions were less in the digoxin group (92 per cent) than in the saline group (88 per cent; p less than 0.001). Serum levels of digoxin at the end of the observation period were well above what is considered the minimum therapeutic level and in three patients the level approached or reached the toxic range. In these three patients there was still no increased incidence of ventricular tachyarrhythmias. It is concluded that patients with acute myocardial infarction complicated by incipient left ventricular failure do not show an increased sensitivity to an ordinary dose of digoxin as measured by the occurrence of ventricular tachyarrhythmia.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Infusions, Parenteral; Male; Middle Aged; Myocardial Infarction; Tachycardia

Left ventricular function was investigated at rest and during exercise by heart catheterization in 15 patients 3-5 months after acute myocardial infarction. The effect of 1 mg digoxin i.v. in ten patients was correlated to placebo (saline solution) in five patients. A significant decrease of the left ventricular enddiastolic pressure, increase of left ventricular systolic ejection fraction and a shift of the left ventricular function curve to left upwards was found after digoxin with no changes in the placebo group. This beneficial effect of acute digitalization in patients convalescing from uncomplicated myocardial infarction without clinical signs of manifest heart failure could have therapeutic implication.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Output; Clinical Trials as Topic; Digoxin; Drug Evaluation; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Physical Exertion

Topics: Acute Disease; Adult; Amitriptyline; Arrhythmias, Cardiac; Clinical Trials as Topic; Death, Sudden; Depression; Digoxin; Electrocardiography; Heart; Humans; Imipramine; Middle Aged

Topics: Acute Disease; Adult; Aged; Blood Pressure; Blood Volume; Cardiac Output; Digoxin; Electrocardiography; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Vascular Resistance

To analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome.. Patients diagnosed with AHF who were in chronic treatment with digoxin, were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge.. We analyzed 2,366 patients on chronic digoxin treatment (median age = 83 years, women = 61%), which was considered adequate in 1,373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin-angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% versus 7.6%, p = 0.05; and 12.6% versus 9.1%, p < 0.001, respectively). No differences were recorded in prolonged stay (35.7% versus 33.8%) or post-discharge adverse events (32.9% versus 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95%CI = 0.85-2.03) for in-hospital mortality; 1.29 (0.74-2.25) for 30-day mortality; 1.07 (0.82-1.40) for prolonged stay; and 0.88 (0.65-1.19) for post-discharge adverse event.. There is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.

Topics: Acute Disease; Aftercare; Aged, 80 and over; Digoxin; Emergency Service, Hospital; Female; Heart Failure; Humans; Patient Discharge; Prognosis

Despite wide usage of digoxin for various diseases in cardiology practice, its benefit is controversial and moreover it had been associated with unfavorable outcomes in some previous studies. The aim of this present study was to demonstrate whether digoxin usage was related with worse outcomes or not in patients with acute pulmonary embolisms.. A total number of 1215 patients retrospectively enrolled for the study. Basic demographic features, pulmonary embolism severity index (PESI) scores, laboratory parameters and medications of patients who had been diagnosed with acute pulmonary embolism were recorded. Short (30 days) and long-term mortality were reported as the clinical outcomes.. Total mortality was 15.4% in the study population and 78 of these subjects died within the first 30 days. The frequency of digoxin treatment was 8% and most of these patients were prior users. According to the binary logistic regression analyses the PESI score, right ventricle (RV) diastolic diameter, systolic pulmonary arterial pressure (sPAP), brain natriuretic peptide (BNP), troponin and digoxin therapy (odds ratio, OR: 2.82 95% confidence interval, CI: 1.39-8.31, P = 0.03) were found as independent predictors of short-term mortality. Beside these findings; sPAP, PESI score, RV diastolic diameter and digoxin therapy (hazard ratio, HR: 2.11 95%CI: 1.22-7.31, P = 0.03) were determined as independent predictors of long-term mortality in Cox regression analyses. In subgroup analysis, we determined significantly greater increase in short-term mortality with use of digoxin among patients who had chronic renal disease, among patients under thrombolytic therapy and under high dosage of digoxin therapy and among female patients.. Digoxin has been used extensively for decades in the treatment of heart failure and arrhythmias despite some controversies over its benefit. For the first time in the literature, we have demonstrated independent association of digoxin therapy with short-term and long-term mortality in patients with acute pulmonary embolism.

Topics: Acute Disease; Digoxin; Female; Humans; Male; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Severity of Illness Index

Topics: Acute Disease; Aged; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Systole; Tachycardia; Ventricular Dysfunction

Pharmacologic cardioversion of atrial fibrillation (AF) is a reasonable mode of treatment if the arrhythmia is of recent onset. Results concerning the response rates of different drugs, respectively, in daily clinical practice and data with regard to the parameters associated with successful cardioversion are not very prevalent.. Three-hundred seventy-six patients who were admitted to the emergency department with acute AF and a duration of shorter than 48 hours were enrolled into the AF registry.. The most effective drugs were flecainide and ibutilide (95% and 76%). Low response rates were observed with amiodarone (36%) and the individual use of digoxin or diltiazem (19% and 18%). Factors associated with a successful cardioversion were a lower blood pressure on admission (P = .002), a shorter time interval between the onset of AF and admission to the ED (P = .003), and adherence to treatment guidelines (P < .0001).. The use of flecainide and ibutilide is associated with a much higher rate of cardioversion than other drugs we studied.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Diltiazem; Emergency Service, Hospital; Female; Flecainide; Humans; Male; Middle Aged; Sulfonamides; Time Factors; Treatment Outcome

Acute heart failure represents an increasingly common cause of hospitalization, and may require the use of inotropic drugs in patients with low cardiac output and evidence of organ hypoperfusion. However, currently available therapies may have deleterious effects and increase mortality. An ideal inotropic drug should restore effective tissue perfusion by enhancing myocardial contractility without causing adverse effects. Such a drug is not available yet. New agents with different biological targets are under clinical development. In particular, istaroxime seems to dissociate the inotropic effect exerted by digitalis (inhibition of the membrane sodium/potassium adenosine triphosphatase) from the arrhythmic effect and to ameliorate diastolic dysfunction (via sarcoendoplasmic reticulum calcium adenosine triphosphatase activation). Additionally, the myosin activator omecamtiv mecarbil appears to have promising characteristics, while genetic therapy has been explored in animal studies only. Further investigations are needed to confirm and expand the effectiveness and safety of these agents in patients with acute heart failure and low cardiac output.

Topics: Acute Disease; Animals; Cardiac Output; Cardiotonic Agents; Clinical Trials as Topic; Digoxin; Dobutamine; Etiocholanolone; Genetic Therapy; Heart Failure; Humans; Hydrazones; Pyridazines; Ryanodine Receptor Calcium Release Channel; Sarcoplasmic Reticulum Calcium-Transporting ATPases; Simendan; Sodium-Potassium-Exchanging ATPase; Urea

Topics: Acute Disease; Cardiology; Cardiotonic Agents; Digoxin; Drug Utilization; Heart Failure; Humans

The prognosis of acute heart failure is such that many children are considered for transplantation. Recovery of severe heart failure in a proportion of patients diagnosed with either dilated cardiomyopathy or myocarditis is well recognized, and this complicates the assessment for transplantation. There is little data on the time scale of recovery of heart function in children.. To describe the time course over which echocardiographic improvement of systolic function occurred in a cohort of children who presented in acute heart failure, without structural or metabolic abnormality.. Children with a first presentation of acute severe heart failure between 1990 and 2005. Time from presentation to the echocardiogram before left ventricular fractional shortening (FS) improved to 20% and 30% (complete recovery) was recorded.. Twenty-seven children (11 male) were identified, and all had an initial FS <15%. Twenty-one patients required intravenous inotropes and three patients required extracorporeal membrane oxygenation. Seven patients had been on the active transplant list for a mean duration of 155 days. Four patients had probable viral myocarditis. Mean age at presentation was 15.7 (range, 0.1-72) months. Mean time to an FS of 20% was 3.6 (0.2-18) months and to 30% was 8.9 (0.7-24) months. Complete recovery occurred within 6, 9, 12, 18, and 24 months of presentation in 44%, 55%, 66%, and 96%, respectively. There was no correlation between age of presentation and length of time to recovery.. Complete recovery of left ventricular systolic function is often delayed to more than 1 year from presentation. This may have major implications for timing of transplantation in an era where prolonged mechanical cardiac support is feasible even in infants.

Topics: Acute Disease; Captopril; Carbazoles; Cardiotonic Agents; Carvedilol; Child; Child, Preschool; Databases, Factual; Digoxin; Enalapril; Enoximone; Female; Heart Failure; Heart Function Tests; Humans; Infant; Infant, Newborn; Male; Propanolamines; Treatment Outcome

Topics: Acute Disease; Acute Kidney Injury; Aged; Antibodies; Digitalis; Digoxin; Humans; Immunoglobulin Fab Fragments; Immunoglobulin Fragments; Plasmapheresis

A 58-year-old woman who had been taking digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma digoxin levels associated with signs and symptoms of toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of digoxin by P-glycoprotein, telithromycin may have decreased digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug toxicity. Clinicians should be aware of possible digoxin toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.

Topics: Acute Disease; Bronchitis; Digoxin; Drug Interactions; Electrocardiography; Female; Heart; Humans; Ketolides; Middle Aged

Topics: Acute Disease; Adolescent; Amphibian Venoms; Animals; Bufo bufo; Digoxin; Female; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Male

Acute digitalis overdosage is characterized by high electric instability, its mortality may reach 10-15 percent even nowadays.. To detect the possible risk factors which might predict severe intoxication.. Data of 50 patients treated at authors' department with acute digoxin poisoning over the past 8 years could be retrospectively evaluated. Cases were classified according to the Poison Severity Score (PSS). The following parameters were taken into consideration: age, sex, diseases influencing the severity of intoxication, dose of the drug, heart frequency, serum potassium and digoxin levels and vomiting. For statistical analysis a Kruskal-Wallis test and a chance-quotient calculation was applied.. From 50 patients 30 were mild (PSS 1, 2), 20 were severely poisoned, which subgroup included 8 deaths (PSS 4) and 12 patients who recovered (PSS 3). Based on Kruskal-Wallis test significant differences were found in the following items: greater number of primary diseases PSS 4 vs other subgroups (p < 0.05); bradycardia PSS 4 vs PSS 2 (p < 0.05) and PSS 3 vs PSS 2 (p < 0.05); hyperkalaemia PSS 3 vs PSS 2 (p < 0.01); elevated serum digoxin level PSS 3 vs PSS 2 (p < 0.05). The risk of severe poisoning (PSS 3-4) was increased in case of hyperkalaemia, bradycardia, vomiting (p < 0.001), and if the patients' age and if the drug dose exceeded 65 years or 10 mg, respectively (p < 0.05).. The predictive risk factors concerning severe acute digoxin poisoning are profuse vomiting, hyperkalaemia and bradycardia. The predictive risk factors of fatal outcome are age over 65 years associated with primary disease, vomiting and bradycardia.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bradycardia; Cardiotonic Agents; Digoxin; Female; Heart Rate; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Vomiting

The need for new treatment strategies for cardiac arrhythmias has motivated our continuing development of gene therapeutic options. Previously, we reported a decreased heart rate in an acute model of atrial fibrillation after atrioventricular nodal gene transfer. Here, we expand those observations to persistent atrial fibrillation and severe heart failure.. After 3 weeks of atrial fibrillation, domestic swine received atrioventricular nodal gene transfer with adenoviruses encoding beta-galactosidase (beta-gal), wild-type Galpha(i2) (wtGi), or constitutively active mutant (cGi). Heart rates in awake, alert animals were not altered by beta-gal or wtGi. cGi caused a sustained 15% to 25% decrease in heart rate. The wtGi effect became evident with sedation. A tachycardia-induced cardiomyopathy was present before gene transfer. In the beta-gal group, cardiomyopathy worsened over time. In the wtGi group, the condition improved slightly, and in the cGi group, ejection fraction was near normal at the end of the study. TUNEL staining results corroborated this finding.. cGi overexpression in the porcine atrioventricular node causes physiologically relevant heart rate control in persistent atrial fibrillation. These data advance the development of gene therapy as a potential treatment for common cardiac arrhythmias.

Topics: Acute Disease; Adenoviridae; Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrioventricular Node; Cardiac Pacing, Artificial; Digoxin; Diltiazem; Gene Expression Regulation; Genetic Therapy; Genetic Vectors; GTP-Binding Protein alpha Subunit, Gi2; GTP-Binding Protein alpha Subunits, Gi-Go; Heart Failure; Heart Rate; Propanolamines; Proto-Oncogene Proteins; Recombinant Fusion Proteins; Stroke Volume; Sus scrofa; Ultrasonography

Topics: Acute Disease; Arrhythmias, Cardiac; Cardiotonic Agents; Causality; Colectomy; Confusion; Digoxin; Diuretics; Electrocardiography; Emergencies; Humans; Hypokalemia; Male; Middle Aged; Muscle Weakness; Nursing Assessment; Paresthesia; Patient Care Planning; Patient Education as Topic; Potassium

Topics: Acute Disease; Aged; Anti-Arrhythmia Agents; Blood Pressure; Cardiac Surgical Procedures; Coronary Angiography; Coronary Disease; Digoxin; Electrocardiography; Female; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Patient Admission; Platelet Glycoprotein GPIIb-IIIa Complex; Prospective Studies; Sex Factors; Stroke Volume; Syndrome; Thrombolytic Therapy; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left

Topics: Acute Disease; Cardiotonic Agents; Digitalis Glycosides; Digoxin; Fatal Outcome; Female; Gastrointestinal Hemorrhage; Humans; Infant; Intestine, Small; Necrosis

Verapamil and digoxin have been shown to modulate tachycardia-induced atrial electrical remodeling. The goal of the present study was to determine the direct effects of verapamil and digoxin on atrial fibrillation (AF), before and after electrical remodeling.. In six goats we measured the AF cycle length (AFCL) and duration of AF (DurAF) of 50 consecutive induced paroxysms, before (t = 0) and after 24 hours (t = 24) of electrical remodeling. During AF, conduction velocity (CV(AF)), refractory period (RP(AF)), and type of AF (I, II, III) were determined. Verapamil was administered at a loading dose of 0.1 mg/kg, followed by a continuous (2-hour) infusion of 5 microg/kg/min. Digoxin was given intravenously as a single 0.02 mg/kg bolus. At t = 0 and t = 24, digoxin and verapamil caused a significant slowing of the ventricular rate of >40%. Digoxin had no effect on DurAF, AFCL, CV(AF), or RP(AF). Infusion of verapamil had a direct proarrhythmic effect. Both at t = 0 and t = 24, AFCL and RP(AF) were shortened by about 15%. During acute AF, verapamil prolonged the average duration of AF paroxysms from 7 to 16 seconds. After 24 hours of AF, the proarrhythmic effect was much stronger. Shortly after starting infusion (6 +/- 2 min), verapamil converted paroxysmal AF into sustained AF. As long as verapamil infusion was maintained, AF no longer terminated in any of the goats. This effect was associated with an increase in AF fragmentation from type I to type II-III.. Verapamil shortens AFCL and RP(AF) in the presence and absence of electrical remodeling. After 24 hours, it exerted a marked proarrhythmic effect and converted paroxysmal (type I) into sustained (type III) AF. In contrast, digoxin had no effect on the rate or stability of AF.

Topics: Acute Disease; Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Pacing, Artificial; Chronic Disease; Digoxin; Disease Models, Animal; Electrocardiography; Electrodes, Implanted; Electrophysiologic Techniques, Cardiac; Goats; Heart Atria; Heart Conduction System; Heart Rate; Injections, Intravenous; Verapamil

Topics: Acute Disease; Anti-Arrhythmia Agents; Atrial Fibrillation; Clinical Trials as Topic; Digoxin; Follow-Up Studies; Heart Rate; Humans; Treatment Outcome

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine that produces left ventricular dysfunction and a negative inotropic effect in cardiac tissue when overexpressed in human subjects. Previous studies have shown that levels of circulating TNF-alpha are elevated in patients with advanced congestive heart failure (CHF) and especially in those with cardiac cachexia. To clarify the potential role of TNF-alpha in the unstable state of decompensated advanced CHF, we investigated the TNF-alpha serum activity in 25 cachectic and 22 non-cachectic CHF patients (New York Heart Association, NYHA functional classes III or IV), who were treated with intravenous diuretics and positive inotropic agents for acute decompensation of the disease, during a 5-day hospitalization period, as well as in 15 age-matched healthy control subjects. Cachectic CHF patients needed higher dosages of inotropic agents than non-cachectic patients and the determination of TNF-alpha serum concentrations in this patient group showed high levels of TNF-alpha at hospital admission (18.3 +/- 3.2 pg/ml) and a transient increase in circulating TNF-alpha during the treatment period with the highest levels on the 2nd day of hospitalization (32.5 +/- 7.1 pg/ml). The TNF-alpha serum levels were low in non-cachectic CHF patients and healthy controls on the 1st day (4.0 +/- 0.9 and 3.7 +/- 0.6 pg/ml, respectively) and did not change substantially during the course of the study. The present results show that TNF-alpha serum activity is transiently increased during the treatment of decompensated cachectic CHF patients only and may be related to the clinical instability and the consequent therapeutic interventions in this category of CHF patients.

Topics: Acute Disease; Adult; Aged; Biomarkers; Body Mass Index; Cachexia; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Furosemide; Heart Failure; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Contraction; Prognosis; Tumor Necrosis Factor-alpha

The diagnosis of supraventricular tachycardia has become much more important with the advent of radiofrequency ablation. This is usually best done at presentation in an acute setting. A 12-lead electrocardiogram should be a routine aid in making the diagnosis. A continuous rhythm strip must be obtained during administration of adenosine and at the termination of tachycardia. Most recent treatment guidelines would include adenosine as first-line therapy. If adenosine fails to restore normal sinus rhythm, diltiazem or a beta blocker should then be considered. If there is significant heart failure, digoxin may be useful. In the presence of wide complexes, agents that produce atrioventricular nodal block should be avoided.

Topics: Acute Disease; Adenosine; Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Calcium Channel Blockers; Catheter Ablation; Digoxin; Diltiazem; Electrocardiography; Humans; Tachycardia, Supraventricular

Topics: Acute Disease; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Electrocardiography; Humans; Infusions, Intravenous

Topics: Acute Disease; Acute Kidney Injury; Cardiotonic Agents; Chronic Disease; Digoxin; Humans; Hyperkalemia

To assess the clinical characteristics and management of patients with atrial fibrillation (AF), we performed a prospective survey of all acute medical admissions over six months to our hospital. Of 7,451 such admissions, 245 had AF (110 male, 135 female; mean age 74.4 years). Of these, 213 were Caucasian, 10 black/Afro-Caribbean and 22 Asian. Complete data were available for 185 patients. Of these, 82 had newly diagnosed AF, 83 had previous chronic AF and 20 had paroxysmal AF. The main presenting features was dyspnoea, stroke and syncope. A history of ischaemic heart disease was present in 64, heart failure in 46, hypertension in 51 and rheumatic heart disease in 13, while 31 had a previous stroke. Chest X-ray showed cardiomegaly and pulmonary oedema in 121 patients, but was normal in 28. Echocardiography showed poor cardiac function in eight patients and enlarged left atria in five. Only 28% of those with previously diagnosed AF were on anticoagulation. Of the newly diagnosed patients, only 18% were started on anticoagulants. Cardioversion was attempted or planned in only 6%. The primary diagnosis on discharge was heart failure in 45, stroke in 24 and myocardial infarction in 12. AF remains a common arrhythmia among acute medical admissions and is commonly associated with heart failure and a high mortality. There is still a reluctance to start anticoagulant therapy or to perform cardioversion in such patients.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Digoxin; Electric Countershock; Female; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Prospective Studies

Phospholipase-A2 has been suggested as having a role in the pathophysiology of acute pancreatitis. The inhibition of phospholipase-A2 was studied in vitro using 17 pharmacological agents in the search for a specific therapy for acute pancreatitis. The inhibitory effect was tested using an isotopic assay system with 2-palmitoyl-(1-14C)-labelled dipalmitoyl phosphatidylcholine as a substrate and 10 microliters of serum from patients with acute necrotizing pancreatitis as an enzyme source. Among all agents tested, anti-inflammatory drugs inhibited enzyme activity most significantly: indomethacin (9.0 x 10(-3) mol l-1) decreased the phospholipase-A2 activity to one- tenth. The weak inhibitory effect could also be demonstrated using a lower concentration of 2 x 10(-5) mol l-1, which can be achieved after intravenous administration of 50 mg of this drug. The other drugs inhibited the enzyme activity at concentrations higher than those achieved after intravenous injections in clinical use. Diclofenac (3.1 x 10(-2) mol l-1) reduced the phospholipase-A2 activity by 93%, ketoprofen (2.0 x 10(-2) mol l-1) or chlorpromazine (1.4 x 10(-2) mol l-1) by 90%, tobramycin (1.7 x 10(-2) mol l-1) by 84%, doxycycline (9.0 x 10(-3) mol l-1) by 61%, dexamethasone (1.7 x 10(-3) mol l-1) by 62%, methylprednisolone (3.8 x 10(-2) mol l-1) by 50%, and pindolol (1.0 x 10(-4) mol l-1) by 59%. A weak inhibition of phospholipase-A2 activity was demonstrated by betamethasone, bupivacaine, digoxin, hydrocortisone, lidocaine, metoprolol, propranolol, and vancomycin. Indomethacin proved the most potent of the tested agents in inhibiting phospholipase-A2 activity in serum from patients with acute pancreatitis and should be further studied in vivo.

Topics: Acute Disease; Adrenergic beta-Antagonists; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Chlorpromazine; Digoxin; Enzyme Inhibitors; Glucocorticoids; Humans; Lidocaine; Pancreatitis; Phospholipases A; Phospholipases A2

To investigate variations in the management of patients with atrial fibrillation among consultant physicians.. Questionnaire survey.. Consultant physicians in England, Wales, and Scotland.. 214 consultant physicians (88 cardiologists and 126 non-cardiologists) were surveyed between May and July 1994. Most physicians (47.7%) reported that they saw one to five patients with atrial fibrillation weekly. Some 52% of cardiologists and 40% of non-cardiologists considered that the main factor influencing their decision of whether or not to anticoagulate was the clinical history--that is, heart failure, valve disease, or stroke. When encountering a patient admitted acutely with new onset atrial fibrillation, significantly more cardiologists (66% v 52%, chi 2 = 6.89, P = 0.03) would immediately start anticoagulant treatment, most favouring intravenous heparin. Most physicians would also introduce antiarrhythmic treatment or digoxin, but more cardiologists would attempt immediate pharmacological (39% v 18% of non-cardiologists, P < 0.001) or later electrical (86% v 69%, chi 2 = 11.7, P = 0.003) cardioversion to sinus rhythm, while non-cardiologists tended to prefer "rate control" with digoxin. Although many physicians would not continue antiarrhythmic treatment post-cardioversion, more cardiologists than non-cardiologists would do so (the commonest choice being class III agents) (31% v 17%, P = 0.04). Fewer non-cardiologists would continue anticoagulant treatment post-cardioversion (27% v 69% of cardiologists, chi 2 = 39.8, P < 0.0001). When treating patients with atrial fibrillation, decisions about anticoagulation were usually related to the perceived relative risk of thromboembolism versus haemorrhage derived for each of six case management scenarios in the questionnaire. There was, however, general agreement between cardiologists and non-cardiologists in the use of antithrombotic treatment in the management of lone atrial fibrillation, paroxysmal atrial fibrillation, and patients with atrial fibrillation and mitral valve disease or thyrotoxicosis.. There is considerable variation in the management of atrial fibrillation, with more cardiologists than non-cardiologists considering cardioversion to sinus rhythm (and the use of antiarrhythmic and anticoagulant treatment post-cardioversion) and thrombo-prophylaxis with anticoagulation. Guidelines on the management of this common arrhythmia are clearly required.

Topics: Acute Disease; Adult; Aged; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiology; Digoxin; Electric Countershock; Female; Heparin; Humans; Male; Medical Audit; Middle Aged; Practice Patterns, Physicians'

Many studies suggest the hypothesis that the pathology of high altitude could be due to an early alteration of the hormones that regulate sodium homeostasis.. The aim of this study was to evaluate the behavior of these hormones during an acute exposure to hypobaric hypoxia.. We studied 26 young healthy pilot students (23.1 +/- 2.9 yrs) in a hypobaric chamber, for 3 h (samples collected at time 0, 120, and 180 min), at 5000 m ASL.. The results show an early increase of plasma renin activity (PRA) paradoxically associated to a decrease of aldosterone plasma levels. This later returned to the baseline values at 180 min, whereas PRA remained increased throughout the exposure. Both arginine-vasopressin (ADH) and the atrial natriuretic peptide (ANP) significantly increased, while a new putative hormone, the so-called digoxin-like substance (DLS) did not show significant changes.. Our data demonstrate a specific sensitivity of the hormonal systems to hypoxia, which may be influenced by the time of the exposure. The relationship with results previously reported is also addressed.

Topics: Acute Disease; Adult; Aerospace Medicine; Aldosterone; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Pressure Monitoring, Ambulatory; Body Water; Cardenolides; Digoxin; Enzyme Inhibitors; Heart Rate; Hormones; Humans; Hypoxia; Male; Potassium; Radioimmunoassay; Renin; Saponins; Sodium; Water-Electrolyte Balance

The aim was to study whether a circulating sodium pump inhibitor (endogenous digoxin-like factor) contributes to the genesis of early ventricular arrhythmias in acute myocardial ischaemia in rats.. Effects of digoxin antibody (260 micrograms.kg-1) on the incidence of ventricular arrhythmias, plasma digoxin-like immunoreactivity (DELFIA immunoassay), Na+, K+, and Mg2+ ions, and activity of the ouabain sensitive Na+, K(+)-pump in different regions of myocardium have been studied in propranolol naive and propranolol pretreated rats exposed to acute coronary artery ligation. Adult male Wistar rats were divided into six experimental groups: (1) saline pretreated controls; (2) saline pretreated coronary artery ligated rats; (3) coronary artery ligated rats pretreated with 260 micrograms.kg-1 digoxin antibody; (4) propranolol pretreated controls; (5) propranolol pretreated rats with acute myocardial ischaemia; (6) rats with acute myocardial ischaemia pretreated with both propranolol and digoxin antibody.. Acute myocardial ischaemia in saline pretreated rats was associated with a twofold increase of plasma digoxin-like immunoreactivity and ventricular arrhythmias, but did not lead to changes in myocardial Na+, K(+)-pump activity. Pretreatment of coronary artery ligated rats with digoxin antibody reduced the total duration of ventricular tachycardia and ventricular fibrillation during a 15 minute postligation period from 201 (SEM 34) to 46(18) seconds (p < 0.002) but did not alter activity of the myocardial Na+, K(+)-pump. In rats pretreated with propranolol, acute myocardial ischaemia was associated with a twofold inhibition of the Na+, K(+)-pump in left atrial and left ventricular myocardium, and with a 69% increase in plasma K+ concentration. Administration of digoxin antibody to propranolol pretreated coronary artery ligated rats in parallel with the antiarrhythmic effect prevented the increase in plasma K+ concentration and inhibition of Na+, K(+)-pump in the left atrial, but not the left ventricular myocardium.. A circulating digoxin-like factor contributes to the pathogenesis of myocardial ischaemia induced ventricular arrhythmias. As propranolol pretreatment of coronary artery ligated rats inhibited the Na, K(+)-pump in myocardium, the inhibitory effect of endogenous digoxin-like factor on Na+, K(+)-ATPase was probably masked in propranolol naive animals by the stimulatory action of catecholamines on Na+, K(+)-ATPase described previously.

Topics: Acute Disease; Animals; Antibodies; Arrhythmias, Cardiac; Blood Proteins; Cardenolides; Digoxin; Male; Myocardial Ischemia; Myocardium; Rats; Rats, Wistar; Saponins; Sodium-Potassium-Exchanging ATPase

Topics: Acute Disease; Digoxin; Drug Overdose; Female; Humans; Infant, Newborn

Patients with severe congestive heart failure often have high plasma Atrial Natriuretic Factor (ANF) and neurohormonal activation. Ace inhibitors give clinical and hemodynamic benefits and lower plasma angiotensin and norepinephrine levels. The interactions between ANF and the Ace inhibitors are mainly modulated via the renin angiotensin system.. Plasma ANF, renin activity, urinary aldosterone and catecholamine levels were evaluated in 10 patients with congestive heart failure (at baseline, after 15 days of adequate treatment with digoxin and diuretics, and after 45 days of enalapril) in order to assess the changes of ANF and vasoconstrictor neurohormones with chronic Ace inhibitor therapy.. ANF increased significantly in the congestive heart failure group compared to a normal subject control group (P < 0.001). After digoxin and diuretic therapy NHYA class improved significantly, but no significant hormonal changes were found. On the contrary, the addition of enalapril caused a significant decrease of plasma ANF and urinary aldosterone and catecholamines (P < 0.05).. The relationship between the renin angiotensin system and catecholamines is complex but our findings indicate that: 1) Traditional therapy is effective in improving symptoms, but cannot induce a decrease of vasoconstrictive neurohormones; 2) ACE inhibitor therapy reduces ANF and neurohormonal activation. 3) ANF is a useful marker in evaluating the response to treatment.

Topics: Acute Disease; Aged; Atrial Natriuretic Factor; Biomarkers; Digoxin; Drug Therapy, Combination; Enalapril; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Renin-Angiotensin System

Life-threatening digitalis intoxication is treated using digoxin specific antibody fragments (Fab) that bind and inactivate the drug. The free digoxin serum concentration could be useful in the management of Fab-treated patients, but the standard methods of measurement can be clinically misleading because Fab anti-digoxin interferes with digitalis immunoassay measurements. A case involving Fab therapy of a digoxin overdosed patient, in which two laboratory methods gave very different results, is reported. The radioimmunologic assay (RIA), widely used in laboratories, yielded high values without relation to true serum free digoxin concentration. On the contrary, the recently introduced fluoroenzymatic sequential immunoassay (FEIA), which accurately measures free glycoside concentration, was a valuable aid in monitoring Fab treatment. Therefore, cardiologists' knowledge of a possible interference of specific anti-digoxin fragment treatment with many immunoassays may greatly enhance the rational management of these patients.

Topics: Acute Disease; Aged; Digitalis; Digoxin; Drug Overdose; Female; Humans; Immunoglobulin Fab Fragments; Monitoring, Physiologic; Plants, Medicinal; Plants, Toxic; Poisoning

A 50-year-old, previously healthy, woman swallowed 1 g digoxin powder, dissolved in water, with suicidal intent. On admission to hospital one hour later, having vomited three times at home, the prominent signs were somnolence and hypersalivation. Serum digoxin level was 3.37 ng/ml. There followed repeated episodes of asystole alternating with ventricular fibrillation requiring cardiopulmonary resuscitation over 90 min and adrenaline administration. Repeated electrical defibrillation, administration of dopamine, phenytoin and lidocaine, as well as transitory transvenous electrical stimulation became necessary. Anti-digoxin antibody fragments were administered, initially 80 mg, to a total of 3,280 mg over 24 hours. After 3 days of intensive care and a further 21 days in hospital she was discharged and referred to psychiatric treatment. This case demonstrates that even severe digoxin poisoning can be successfully treated without sequelae by the appropriate administration of digoxin antidote. The main problems in this case were regulation of the dosage and acquiring the necessary amount of antidote which greatly exceeded the hospital's own depot.

Topics: Acute Disease; Antidotes; Combined Modality Therapy; Digitalis; Digoxin; Drug Overdose; Drug Therapy, Combination; Female; Gastric Lavage; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic; Poisoning; Powders; Suicide, Attempted; Ventricular Fibrillation

We prospectively studied 69 consecutive patients hospitalized with a primary diagnosis of acute left ventricular failure so as to assess the impact of vasodilators on incidence and morbidity of acute symptomatic left ventricular failure. The determinants of duration of hospitalization, in-hospital mortality and symptomatic status 2 months after discharge were examined. There were 9 in-hospital deaths (13%), and survival at 60 days was 77%. Median duration of hospitalization was 9 days, and 33% of the surviving patients remained in New York Heart Association functional class III-IV 60 days subsequent to discharge. Of the patients, 49 (76%) had previously received treatment for left ventricular failure: 30 (61%) of these had received vasodilators, most commonly angiotensin converting enzyme inhibitors and nitrates. Ischaemic chest pain was present in 34 (49%) of the patients. Acute utilization of vasodilators (45% of patients) was largely limited to nitrate therapy associated with ischaemic chest pain (P less than 0.01). Multiple logistic regression revealed previous left ventricular failure, advanced age and hypokalaemia as significant correlates of prolonged hospitalization (greater than 9 days). Previous left ventricular failure was also predictive of persistent severe disability two months subsequent to discharge. No factor was a significant predictor of in-hospital death. Although preceding treatment with digoxin and incremental angiotensin converting enzyme inhibitor therapy tended to predict brief hospitalization, the parameter of acute ischaemia, other biochemical anomalies and modes of acute or chronic therapy were not significant correlates of any end point. We conclude that preceding disability, rather than mode of treatment, predicts an adverse outcome in acute left ventricular failure.

Topics: Acute Disease; Aged; Aged, 80 and over; Chronic Disease; Digoxin; Diuretics; Female; Follow-Up Studies; Heart Failure; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Multivariate Analysis; Nitrates; Patient Admission; Prospective Studies; Regression Analysis; South Australia; Survival Rate; Treatment Outcome; Vasodilator Agents

Topics: Acute Disease; Aged; Aged, 80 and over; Antibodies; Digoxin; Humans; Male

Topics: Acute Disease; Adult; Aged; Canrenoic Acid; Chronic Disease; Digoxin; False Positive Reactions; Female; Humans; Immunoenzyme Techniques; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Pregnadienes; Radioimmunoassay; Random Allocation

10 patients with acute digitalis intoxication were treated by charcoal hemoperfusion. The patients had taken high toxic and lethal doses of digitalis drugs: 3 patients had taken 10 mg of (digitalin, 2 patients--7.5 mg of digoxin, 5 patients--10-25 mg of isolanid (ceglunat). 4 of the patients were with a heart disease and the other 6 patients did not have any heart disease. The charcoal hemoperfusion lasted 4 to 6 hours, in one female patient--2 hours. The mean minute volume was 100 to 150 ml/min, in some patients it reached up to 200 ml/min. The digoxin blood concentration was determined before and after the hemoperfusion in 4 patients and a decrease of 49% was found. 9 patients fully recovered and only one patient, a 70 years old women, who had not received antiarrhythmic treatment, died. Good results were also achieved in digitalin intoxications determined by the clinical course and the electrocardiographic data. The overall estimation of the method is that it is efficient and should be applied to patients with acute digitalis intoxication, always in combination with antidote, antiarrhythmic and cardioprotective treatment.

Topics: Acute Disease; Adolescent; Adult; Aged; Charcoal; Digitalis Glycosides; Digoxin; Electrocardiography; Female; Hemoperfusion; Humans; Lanatosides; Male; Middle Aged; Time Factors

We studied the effects of digoxin, a compound that has an inotropic effect on the myocardium, on diaphragmatic function in 8 patients with chronic obstructive pulmonary disease. All the patients were in acute respiratory failure and were artificially ventilated. Diaphragmatic strength was assessed by measuring the transdiaphragmatic pressure generated at functional residual capacity during bilateral supramaximal electrical stimulation of the phrenic nerves. The latter were stimulated before and at 45 and 90 min after administration of digoxin (0.02 mg/kg infused for 10 min). In all the patients, cardiac output was measured by the thermodilution technique using a Swan-Ganz catheter placed in the pulmonary artery. Arterial blood gases and pH were maintained within normal range by mechanical ventilation. In all the patients, digoxin plasma levels reached the therapeutic range (mean values, 2.82 +/- 0.17 and 2.90 +/- 0.20 nmol/L at 45 and 90 min, respectively) after digoxin administration. Diaphragmatic strength improves significantly after digoxin administration, the transdiaphragmatic pressure for an identical phrenic stimulation increasing by 19.5% (p less than 0.001) on the average. This increase was noted 45 and 90 min after digoxin administration. We conclude that digoxin has a potent effect on diaphragmatic strength generation that may be beneficial in patients with chronic obstructive pulmonary disease during acute respiratory failure. Furthermore, this inotropic positive effect of digoxin on the diaphragm, as previously observed for the myocardium, emphasizes the similarities between these 2 contractile tissues.

Topics: Action Potentials; Acute Disease; Aged; Diaphragm; Digoxin; Female; Hemodynamics; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pressure; Respiratory Insufficiency

Acute digitalis intoxication is infrequent and severe. The mortality rate is between 15 and 20 per cent. Its treatment has been greatly improved with the appearance, in 1976, of a specific serotherapy: Fab fragments of antidigoxin antibodies. The clinical experiment reported in the literature relates to approximately one hundred cases and establishes that this therapy has a practically constant and non dangerous efficacy. The lack of availability of these fragments Fab represents presently the only obstacle to the development of this treatment, but the use of monoclonal antibodies, already available experimentally, should, in the future, circumvent this last hurdle.

Topics: Acute Disease; Digitalis Glycosides; Digoxin; Humans; Immunoglobulin Fab Fragments

Topics: Acute Disease; Aged; Charcoal; Digoxin; Humans; Male; Methods

Forty-seven episodes of acute atrial fibrillation (AF) in 45 patients were examined prospectively to determine the course of the disorder treated with rapid digitalization. Patients received 1.5 mg of digoxin intravenously over 12 hours. In 40 of the 47 attacks, reversion to sinus rhythm occurred with no additional therapy at 1 to 96 hours (median 4 hours) after beginning digoxin. In thirty-two patients, conversion occurred within 8 hours; only one patient showed important ventricular slowing before conversion. Thus, if digoxin facilitates conversion, it does not do so by slowing the ventricular response. Of the 11 patients still in AF at 16 hours, conversion subsequently occurred in only four who were receiving digoxin alone. We conclude that the prognosis for quick reversion to sinus rhythm in patients with acute AF treated with rapid digitalization alone is excellent. If reversion does not occur by 16 to 24 hours, additional measures to restore sinus rhythm are indicated.

Topics: Acute Disease; Atrial Fibrillation; Digoxin; Heart Rate; Humans; Middle Aged

A patient with acute nonlymphoblastic leukemia in relapse and anthracycline cardiomyopathy was treated with AMSA in combination with cytosine arabinoside and thioguanine (AAT). Induction of remission was accomplished after one course of therapy without development of congestive heart failure. Radionuclide studies done prior to and subsequent to the reinduction with AAT revealed that the combination did not induce further deterioration of myocardial function. Although the exact risk of AMSA causing additional cardiac damage will require more extensive experience, this case suggests that AMSA may be safely given to patients with anthracycline cardiomyopathy and may be the treatment of choice for this group of patients.

Topics: Acute Disease; Adult; Aminoacridines; Amsacrine; Antibiotics, Antineoplastic; Antineoplastic Agents; Digoxin; Female; Furosemide; Heart Diseases; Humans; Leukemia; Naphthacenes

Topics: Acute Disease; Body Surface Area; Digoxin; Electrocardiography; Humans; Myocardial Infarction; Necrosis; Propranolol

In the acute stage of transmural myocardial infarction, 22 patients ranging in age from 34 to 76 (mean 61.6) were given propranolol- because of its alleged myocardium-protecting properties - intravenously at a dosage of 0.03 to 0.1 mg/kg body weight under conditions of continuous hemodynamic control. Subsequently, the influence of digoxin, administered i. v. at a dosage of 0.01 my/kg body weight, on the negative-inotropic propranolol effects was examined. A hemodynamic comparison was made of the effects of propranolol before and after digitalis administration. In patients with compensated cardiac function (group 1, 16 patients), the propranolol-induced drop in the left ventricular stroke-work-index and rise in the left-ventricular filling pressure was completely compensated again by digitalis. The frequency-decreasing propranolol effect was nor influenced by digitalis. In patients with cardiac decompensation (group 2, 6 patients) digitalis only led to a renewed compensation of the left-ventricular stroke-work-index, the rise of the left-ventricular filling pressure remained unaffected. It follows from that, in cases of myocardial infarction without cardial decompensation, propranolol requires concomitant digitalisation. In cases of already existent myocardial insufficiency, propranolol can produce an unfavorable increase of the decompensation signs.

Topics: Acute Disease; Adult; Aged; Digoxin; Drug Therapy, Combination; Female; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Propranolol

The left ventricular filling pressure (LVFP) was measured within 12 hours of onset of acute myocardial infarction (AMI) in 99 patients, including 21 nonsurvivors. Initial LVFP for survivors was 18 +/- 6 mm Hg (mean +/- SD) and for nonsurvivors was 24 +/- 8 mm Hg (p less than 0.005). Of the total population, 87% had initial LVFP of 12 mm Hg or greater and all nonsurvivors were in this group. Life table analysis was employed to determine LVFP related mortality rates. If initial LVFP was less than or equal to 18 mm Hg, 72-hour mortality rate was 4% and 30-day mortality rate was 10%. For initial LVFP greater than 18 mm Hg, 72-hour mortality rate was 21% and 30-day mortality rate was 33% (p less than 0.005 for both 72 hours and 30 days). When final LVFP was analyzed 30-day mortality rate for final LVFP less than or equal to 18 mm Hg was 5%. Mortality rate of 60% was observed for final LVFP greater than 18 mm Hg. We compared sequential measurements of LVFP in a subset of survivors and nonsurvivors and observed that long-term average trend was for survivors to decrease their LVFP. We conclude that AMI mortality rate is related to LVFP and that LVFP greater than 18 mm Hg is associated with very high mortality rate when compared to LVFP less than or equal to 18 mm Hg. Thus reduction of LVFP either spontaneously or as result of therapy may lower AMI mortality rate.

Topics: Actuarial Analysis; Acute Disease; Aged; Blood Pressure; Digoxin; Female; Furosemide; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Nitrates; Prognosis; Sympathomimetics; Time Factors

Topics: Acute Disease; Adolescent; Adult; Aged; Animals; Digitoxin; Digoxin; Dogs; Hemoperfusion; Humans; Middle Aged; Polystyrenes; Polyvinyls

Hypokalemia potentiated the arryhthmogenic effects of digoxin and promoted inhibition of cardiac Na+,K+-ATPase. Acute hypokalemia did not modify digoxin-induced inotropy and therefore altered the quantitative relationship between inhibition of Na+,K+-ATPase and positive inotropy. Chronic hypokalemia impaired the positive inotropic response to digoxin and to isoproterenol in the absence of an electron microscopically detectable cardiomyopathy.

Topics: Acute Disease; Adenosine Triphosphatases; Animals; Chronic Disease; Digoxin; Dogs; Hypokalemia; Isoproterenol; Myocardial Contraction; Potassium; Sodium

Topics: Acute Disease; Coronary Disease; Digoxin; Humans; Lidocaine; Tachycardia; Ventricular Fibrillation

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Output; Digoxin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Ferricyanides; Heart Failure; Hemodynamics; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Nitroprusside; Pulmonary Circulation; Vascular Resistance

Topics: Acute Disease; Catecholamines; Chronic Disease; Digoxin; Diuretics; Electrolytes; Fatty Acids; Glucose; Heart Conduction System; Heart Failure; Hemodynamics; Humans; Myocardial Contraction; Myocardium; Phentolamine; Phosphodiesterase Inhibitors; Vasodilator Agents

Atrioventricular nodal alternating Wenckebach periods were defined as episodes of 2:1 atrioventricular block in which there was a gradual increase in transmission intervals of conducted beats ending in two or three consecutively blocked atrial impulses. This is one of the mechanisms whereby 2:1 atrioventricular block progresses into 3:1 or 4:1 atrioventricular block. Alternating Wenckebach periods appear during rapid atrial pac,ng (even in the absence of depressed atrioventricular nodal function), provided that the atria can be captured at a rate fast enough to allow for the occurrence of this phenomenon. Treatment of atrial flutter with digoxin and quinidine produces alternating Wenckebach's periods, with associated electrocardiographic changes specific for the type of drug given. In patients with "atrial tachycardia with atrioventricular block" due to digitalis intoxication or with primary disease of the conducting system or with acute myocardial infarction, there are coexisting severe arrhythmias and clinical symptoms requiring almost immediate pharmacologic or electrical therapy. We conclude that atrioventricular nodal alternating Wenckebach's periods are common and frequentyly transient and that they occur in a variety of clinical conditions, most of which are benign; however, contrary to what is commonly accepted, some episodes appear in clinical settings requiring prompt pharmacologic or electrical treatment.

Topics: Acute Disease; Atrial Flutter; Atrioventricular Node; Bundle of His; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Atria; Heart Block; Heart Conduction System; Heart Diseases; Humans; Myocardial Infarction; Pacemaker, Artificial; Purkinje Fibers; Quinidine; Tachycardia

Topics: Acute Disease; Digoxin; Hepatitis; Humans

Topics: Acute Disease; Chlorthalidone; Digoxin; Female; Humans; Hypertension; Immunoglobulin E; Middle Aged; Nephritis, Interstitial

Topics: Acute Disease; Digoxin; Drug Therapy, Combination; Electric Countershock; Humans; Lidocaine; Myocardial Infarction; Procainamide; Ventricular Fibrillation

Topics: Acute Disease; Adult; Aged; Arrhythmias, Cardiac; Digoxin; Female; Humans; Male; Middle Aged

Topics: Acute Disease; Adolescent; Arrhythmias, Cardiac; Digoxin; Female; Glucose; Humans; Insulin; Water-Electrolyte Balance

Topics: Acute Disease; Cardiac Output; Digitalis Glycosides; Digoxin; Furosemide; Heart Failure; Heart Rate; Heart Ventricles; Humans; Myocardial Contraction; Myocardial Infarction; Oxygen Consumption; Shock, Cardiogenic; Stimulation, Chemical

Topics: Acute Disease; Child, Preschool; Digoxin; Diuretics; Heart Diseases; Humans; Infant; Infant, Newborn; Respiratory Tract Infections; Strophanthins

Topics: Acute Disease; Child; Child, Preschool; Chronic Disease; Coronary Disease; Digoxin; Humans; Infant; Infant, Newborn; Myocarditis; Pneumonia; Strophanthins

Topics: Acute Disease; Adult; Blood Pressure; Digoxin; Heart Failure; Humans; Shock

In 59 digitalized and 3 non digitalized patients the effect of digitalis during the 1st to 4th days after transmural myocardial infarction was controlled. Rhythm disturbances in acute myocardial infarction may arise secondary to a complicating cardiac failure and may be influenced by digitalis. In 9 of 17 cases (53 p.c.) with ventricular or supraventricular extrasystoles daily doses of 0,4 mg beta-Methyldigoxin or 0,4 mg Digoxin i.v. resulted in undisturbed sinus rhythm. In two cases supraventricular tachycardia and extrasystoles with rapid ventricular rate were abolished by 1,2 mg beta-Methyldigoxin within 12 hours, in three other cases an improvement was recorded. Dysrhythmias or other complications did not occur in previously non digitalized patients. When the antiarrhythmic effect of digitalis cannot be obtained cardiodepressive complications by treatment with typical antiarrhythmic agents are diminished. In patients on digitalis and in cardiogenic shock, digitalization should be performed carefully. Intoxication leads to a diminution of cardiac output and to cardiac dysrhythmias.

Topics: Acute Disease; Adult; Aged; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Digitalis Glycosides; Digoxin; Drug Interactions; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Premedication; Shock, Cardiogenic; Tachycardia

In 20 patients with acute myocardial infarction hemodynamic controls were performed after digitalisation and following i.v. injection of 0,4 mg of Prindolol. Circulatory changes were most pronounced 5-15 min after Prindolol injection and consisted of decrease in heart rate of 7%, mean arterial blood pressure of 6%, cardiac output of 10,5%, stroke volume index of 5,1% and left ventricular work of 18%. An increase of pulmonary wedge pressure of 17%, pulmonary pressure of 9%, mean right atrial pressure of 16% and peripheral arterial resistance of 6% were calculated. In 5 cases a favourable effect on extrasystoles and in 2 cases on sinus tachycardia were observed. Not infrequently, during the initial phase of acute myocardial infarction, a hyperadrenergic state may be noted. Prindolol may be indicated, when circulatory changes or arrhythmias are suspect to be the result of this hyperadrenergic stimulation. A simultaneous digitalisation may inhibit a more intensive cardiodepression.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Complexes, Premature; Cardiac Output; Digitalis Glycosides; Digoxin; Female; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Pindolol; Pulmonary Artery; Shock, Cardiogenic; Tachycardia; Time Factors; Vascular Resistance

Pharmocokinetics and metabolism of digoxin and beta-methyldigoxin have been studied in patients with acute hepatits after intravenous administration of both H-labeled glycosides. In contrast to digoxin, the rate of decline of radioactivity after administration of beta-methyldigoxin was significantly retarded in patients with acute hepatitis. The increase in plasma concentration after beta-methyldigoxin to patients with acute hepatitis is probably related to decreased demethylation.

Topics: Acute Disease; Adult; Aged; Chromatography, Thin Layer; Digoxin; Female; Hepatitis; Humans; Kinetics; Male; Methylation; Middle Aged

To determine the prognostic significance of ventricular arrhythmias persisting during the hospital ambulatory phase of acute myocardial infarction, 64 patients with acute myocardial infarction underwent continuous 10-hour Holter monitoring an average of 11 days after discharge from the coronary care unit (CCU). Patients were categorized according to the results of ambulatory monitoring: 27 patients had ventricular extrasystoles, which were complicated (multifocal, R on T, paired, more than 5/min), or ventricular tachycardia; 22 had uncomplicated premature ventricular contractions; and 15 exhibited no ventricular arrhythmias. The 64 patients were followed prospectively for an average course of 25.8 months; 12 died suddenly; 8 died of other causes, and 44 survived. In all patients who died suddenly, ventricular ectopy was recorded on Holter monitoring before their discharge from the hospital (complicated premature ventricular contractions, eight patients; uncomplicated premature ventricular contractions, four patients); there were no sudden deaths in the patients without ventricular arrhythmias. Patients who died suddenly and those survived were similar in respect to age (60, 62 years), sex, location of infarction, presence of coronary risk factors, severity of acute myocardial infarction (Q waves, cardiac enzymes), serum cholesterol levels, evidence of cardiomegaly on roentgenograms, presence of ventricular gallop and drug therapy received. The occurrence of acute arrhythmias in the CCU did not separate patients who died suddenly from those who survived; there were no differences in ventricular tachycardia or ventricular fibrillation (3 or 12 patients who died suddenly, 6 of 44 patients who survived) or complicated premature ventricular contractions (4 or 12 patients who died suddenly, 18 of 44 patients who survived). Electrocardiograms obtained late in the hospital course revealed no differences in the extent of Q or T wave changes between these two groups. However, the extent of S-T segment abnormality was greater in patients who died suddenly than in patients who survived (5.6 compared to 1.8 leads/standard tracing, p smaller than 0.02) suggesting that the arrhythmias in the former were related to persistent ischemia or segmental ventricular dyssynergy. Thus, in this relatively small number of patients, ventricular arrhythmias persisting late in the hospital course of patients admitted for acute myocardial infarction are shown to predispose to subsequen

Topics: Acute Disease; Adult; Aged; Arrhythmias, Cardiac; Aspartate Aminotransferases; Creatine Kinase; Death, Sudden; Digoxin; Diuretics; Female; Follow-Up Studies; Heart Failure; Hospitalization; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Myocardial Infarction; Potassium; Procainamide; Quinidine; Sodium; Time Factors

Physiologic concepts relating to reperfusion of ischemic areas of myocardium may be applied both to acute coronary insuficiency, manifested by angina pectoris, and to restoration of coronary blood flow by coronary bypass procedures, currently employed both in acute myocardial infarction and in chronic myocardial ischemia for relief of angina pectoris. Of the information currently available from experimental studies, much may be applicable to the clinical situation. After acutr transient coronary occlusion mechanical and electrical properties of the ischemic area rapidly return to normal, but there is prolongation of tension development and occurrence of ventricular arrhythmias; implications of these phenomena for clinical coronary ischemia deserve exploration. Following more prolonged coronary ischemia, results of experimental reperfusion appear to be variable and, although restoration of function following several hours of ischemia is possible, certain deleterious effects are often observed in the form of myocardial edema and hemorrhage. Clinical use of bypass procedures in acute myocardial infarction suggests that results may be good, but that deleterious effects are occasionally observed; occurrence of the later requires definition and explanation. Restoration of myocardial blood flow in the presence of normal left ventricular function in chronic coronary artery disease, and failure to reverse functional abnormalities when left ventricular damage has already ensued in the clinical situation, appears to be well established; however, better methods to assess the potential for recovery of function following revascularization are needed in both acute and chronic coronary artery diseases. It is anticipated that more careful exploration of pathophysiology both in the catheterization laboratory and in the operating room may aid this process.

Topics: Acute Disease; Animals; Cardiac Catheterization; Coronary Circulation; Coronary Disease; Digoxin; Electrocardiography; Heart; Heart Conduction System; Humans; Myocardial Infarction; Myocardial Revascularization; Myocardium; Oxygen Consumption

This study examines indices of respiratory function in mitochondria prepared from transiently ischemic myocardium that had been reperfused in order to evaluate the validity of performing early surgical revascularization procedures. Experiments were performed in pigs with temporary ligation (15-80 min) of an anterior descending coronary artery followed by a 2-hr reperfusion period. Mitochondria preparations were studied simultaneously from normal and reperfused mitochondria in malate and glutamate substrates using the polarographic method. Results revealed a marked decrease of oxygen consumption of mitochondria from reperfused myocardium with relative preservation of oxidative phosphorylation (near normal ADP/O ratio). These results are compatible with a block in electron transport, a theory which was further supported by the data obtained using dinitrophenol as an uncoupler. Additional studies suggested the block was located at site I in the electron transport chain since mitochondrial oxygen consumption, including ATP-linked oxygen consumption, was enhanced by the use of succinate in combination with glutamate. The abnormal mitochondrial function observed is probably due to ischemia persisting despite reperfusion.

Topics: Acute Disease; Adenosine Diphosphate; Animals; Coronary Disease; Coronary Vessels; Digoxin; Glutamates; Malates; Mitochondria, Muscle; Myocardium; Oxygen Consumption; Perfusion; Succinates; Swine

Topics: Acute Disease; Adult; Aged; Blood Glucose; Blood Specimen Collection; Catecholamines; Cholesterol; Cyclic AMP; Cyclizine; Diazepam; Digoxin; Fatty Acids, Nonesterified; Female; Furosemide; Humans; Hydrocortisone; Insulin; Lidocaine; Lipids; Male; Middle Aged; Morphine; Myocardial Infarction; Myocardium; Time Factors; Triglycerides

Topics: Acute Disease; Animals; Blood Pressure Determination; Blood Volume Determination; Cardiac Output; Chronic Disease; Computers; Digoxin; Dogs; Heart Function Tests; Heart Rate; Heart Ventricles; Humans; Muscle Contraction; Phenylephrine; Reaction Time; Stress, Physiological; Ventricular Function

Topics: Acute Disease; Adult; Aged; Cardiac Volume; Digoxin; Heart; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Time Factors

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Catheterization; Digoxin; Female; Furosemide; Germany, West; Heart Diseases; Heart Failure; Heart Septum; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Prognosis; Pulmonary Artery; Pulmonary Edema; Rupture, Spontaneous; Shock, Cardiogenic; Strophanthins

Topics: Acute Disease; Adult; Atropine; Bradycardia; Digoxin; Electrocardiography; Female; Furosemide; Humans; Hyperkalemia; Intensive Care Units; Pacemaker, Artificial; Poisoning; Radioimmunoassay; Suicide

Topics: Acute Disease; Biological Transport, Active; Digoxin; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Magnesium; Male; Phenytoin; Poisoning; Potassium; Respiratory Distress Syndrome, Newborn; Sodium; Vomiting

Topics: Acute Disease; Arrhythmias, Cardiac; Bradycardia; Digoxin; Electrocardiography; Humans; Hypercalcemia; Male; Middle Aged; Nausea; Suicide; Vomiting

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Blood Pressure Determination; Coronary Care Units; Digitalis Glycosides; Digoxin; Drug Hypersensitivity; Electrocardiography; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Ouabain; Strophanthins

Topics: Acute Disease; Animals; Blood Pressure; Chronic Disease; Coronary Circulation; Coronary Vessels; Digoxin; Dogs; Electrocardiography; Electrodes; Heart Ventricles; Ischemia; Ligation; Myocardial Infarction; Time Factors; Tritium

Topics: Acute Disease; Digitalis Glycosides; Digoxin; DNA; Humans; Leukemia; Leukocytes; Ouabain; Radioimmunoassay; Time Factors

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Lung Diseases; Male; Myocardial Infarction; Poisoning; Prognosis; Prospective Studies; Radioimmunoassay

Topics: Acute Disease; Animals; Blood Pressure; Digitalis Glycosides; Digoxin; Dogs; Electrocardiography; Heart Rate; Hypokalemia; Muscles; Myocardium; Potassium; Renal Dialysis; Sodium; Tritium

Topics: Acute Disease; Bradycardia; Digoxin; Female; Hearing Disorders; Heart Diseases; Heart Failure; Humans; Myocardial Infarction; Nitroglycerin; Vestibular Function Tests

Topics: Acute Disease; Animals; Binding Sites; Digoxin; Dogs; Hyperkalemia; Injections, Intravenous; Myocardium; Potassium; Tritium

Topics: Acute Disease; Adult; Aspirin; Child; Demography; Digoxin; Female; Hospitalization; Humans; Male; Penicillin G Benzathine; Penicillins; Phenobarbital; Rheumatic Fever; Rheumatic Heart Disease; Socioeconomic Factors; Steroids; Streptococcus; Sulfadiazine; Virginia

Topics: Acute Disease; Animals; Digoxin; Dogs; Extracellular Space; Hyperkalemia; Injections, Intravenous; Kidney; Liver; Muscles; Myocardium; Spleen; Tritium