digoxin and Aortic-Valve-Stenosis

Topics: Anti-Arrhythmia Agents; Aortic Valve Stenosis; Digoxin; Echocardiography; Echocardiography, Doppler, Color; Female; Fetal Heart; Gestational Age; Heart Block; Heart Defects, Congenital; Humans; Pregnancy; Tachycardia; Ultrasonography, Prenatal

Hydrops fetalis is rarely associated with congestive heart failure caused by obstructive left-sided heart lesions. There are rare cases of live born neonates with critical congenital valvar aortic stenosis and hydrops reported in the literature, all with fatal outcomes. This report describes, to the best of our knowledge, the first two newborns who were diagnosed prenatally to have hydrops fetalis caused by critical valvar aortic stenosis, who were treated prenatally with digoxin and who postnatally had successful percutaneous balloon aortic valvuloplasty. Both patients had not only left but right ventricular dysfunction. We speculate that right ventricular dysfunction was a contributing factor in the development of hydrops in these patients and in utero medical therapy with digoxin is associated with resolution of the hydrops before delivery.

Topics: Angioplasty, Balloon; Aortic Valve Stenosis; Cardiotonic Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Hydrops Fetalis; Infant, Newborn; Male; Pregnancy; Pregnancy Outcome; Ultrasonography, Prenatal

In the setting of low-flow/low-gradient aortic stenosis (LF/LGAS), outcomes of pseudo-severe aortic stenosis (AS) remain poorly described. This study was aimed to assess the outcome of patients with pseudo-severe AS under conservative treatment.. Among 305 patients from the European Registry of LF/LGAS, the outcomes of the 107 patients followed under conservative treatment were analysed. Based on the results of dobutamine echocardiography, patients were divided into group IA [left ventricular (LV) contractile reserve present with true-severe AS, n = 43], group IB [pseudo-severe AS (n = 29) defined as LV contractile reserve with a final aortic valve area ≥1.2 cm(2) and a mean transaortic pressure gradient <40 mmHg at peak dobutamine infusion], or group II (exhausted LV contractile reserve, n = 35). The rate of death within 5 years was significantly lower in the group IB (43 ± 11%, n = 10), when compared with the group IA (91 ± 6%, n = 33; P = 0.001) and the group II (100%, n = 23; P < 0.001). The Cox proportional hazard model analysis demonstrated that the hazard ratio for death in the group IB remained significantly lower than in the other groups, even after adjustment for currently established risk factors. Furthermore, the 5-year survival of pseudo-severe AS patients was comparable with that of propensity-matched patients with systolic heart failure and no evidence of valve disease.. In patients with pseudo-severe AS, the 5-year survival under conservative treatment is better than in true-severe AS and comparable with that of propensity-matched patients with LV systolic dysfunction and no evidence of valve disease. Further studies are needed to define optimal therapeutic management in these patients.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Aortic Valve Stenosis; Digoxin; Echocardiography, Stress; Female; Heart Failure, Systolic; Humans; Kaplan-Meier Estimate; Male; Prospective Studies; Treatment Outcome

Topics: Adult; Anesthesia, General; Anesthesia, Obstetrical; Aortic Valve; Aortic Valve Stenosis; Cardiotonic Agents; Cesarean Section; Digoxin; Echocardiography; Female; Humans; Pregnancy; Severity of Illness Index; Triplets; Young Adult

The aims of this study were to investigate the clinical outcomes of patients with low-gradient aortic stenosis despite preserved left ventricular ejection fraction and to assess reliable prognostic clinical-instrumental features in patients experiencing or not experiencing aortic valve replacement (AVR). Clinical-laboratory and echocardiographic data from 167 patients (median age 78 years, interquartile range 69 to 83) with aortic valve areas <1.0 cm(2), mean gradients ≤30 mm Hg, and preserved left ventricular ejection fraction (≥55%), enrolled from 2005 to 2010, were analyzed. During a mean follow-up period of 44 ± 23 months, 33% of patients died. On multivariate analysis, independent predictors of death were baseline New York Heart Association functional class III or IV (hazard ratio 2.16, p = 0.038) and atrial fibrillation (hazard ratio 2.00, p = 0.025). Conversely, AVR was protective (hazard ratio 0.25, p = 0.01). The magnitude of the protective effect of AVR seemed to be relatively more important in patients with atrial fibrillation than in those in sinus rhythm, independently of the severity of symptoms. Age >70 years showed a trend toward being a prognostic predictor (p = 0.082). In conclusion, in patients with low-gradient aortic stenosis despite a preserved left ventricular ejection fraction, AVR was strongly correlated with a better prognosis. Patients with atrial fibrillation associated with advanced New York Heart Association class had the worst prognosis if treated medically but at the same time a relative better benefit from surgical intervention.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Anticoagulants; Aortic Valve; Aortic Valve Stenosis; Atrial Fibrillation; Calcium Channel Blockers; Cardiovascular Agents; Digoxin; Diuretics; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Multivariate Analysis; Nitroglycerin; Platelet Aggregation Inhibitors; Prognosis; Proportional Hazards Models; Severity of Illness Index; Stroke Volume; Treatment Outcome

The time course of myocardial uptake of metaiodobenzylguanidine ([123I]MIBG) was studied in 26 patients: seven control subjects (Group 1) and 13 patients with left ventricular hypertrophy secondary to valvular aortic stenosis. Seven of these had received no treatment (Group 2) and six were receiving amiodarone or digoxin (Group 3); six heart transplant recipients were investigated for extra neuronal myocardial uptake of [123I]MIBG (Group 4). The index of myocardial [123I]MIBG uptake was lower in Groups 2 and 3 than in Group 1 (Group 2: 1.42 +/- 0.07, p < 0.001; Group 3: amiodarone, 1.30 +/- 0.10, p < 0.05; digoxin, 1.22 +/- 0.06, p < 0.01; Group I: 1.83 +/- 0.18) and lower in Group 3 than in Group 2. Patients of Group 4 showed a much lower mean index of myocardial [123I]MIBG uptake than the control group (1.07 +/- 0.08, p < 0.001).. 1. Patients with left ventricular hypertrophy secondary to valvular aortic stenosis were found to have lower myocardial [123I]MIBG activity and rapid washout than the control subjects. 2. Amiodarone and digoxin partially inhibited myocardial [123I] MIBG uptake. 3. Extra neuronal myocardial uptake of [123I]MIBG in humans only accounts for 13% of the total cardiac activity.

Topics: 3-Iodobenzylguanidine; Adult; Aged; Amiodarone; Aortic Valve Stenosis; Contrast Media; Digoxin; Female; Heart; Heart Transplantation; Humans; Hypertrophy, Left Ventricular; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Radionuclide Imaging

A decrease in the cardiac function and intracellular calcium, and an increase in the cardiac sarcolemmal ATPase have been reported in aortic stenosis of 6 to 9 months duration in dogs. The present investigation deals with the effect of 3 months of digoxin treatment on cardiac function, electrolytes and ATPase in dogs with 3 months of aortic stenosis in order to determine whether digoxin treatment gives only haemodynamic improvement or if it also improves the condition of the myocardium in terms of contractility and biochemical changes. There were no significant changes in any of the haemodynamic parameters of left and right ventricles except the left ventricular end-diastolic pressure which increased significantly at 3 months of aortic stenosis. All the hearts developed left ventricular hypertrophy. Concomitant with these changes, there was a tendency for a decrease in the total tissue Ca2+, intracellular Ca2+ and K+, and a tendency for an increase in the sarcolemmal ATPase. There were no significant differences in any of the haemodynamic parameters between the aortic stenotic and digoxin treated aortic stenotic dogs indicating that digoxin was at least maintaining the haemodynamics close to the pretreatment level. Although digoxin treatment prevented the changes in the sarcolemmal ATPase and extracellular space, it did not prevent the further decrease in the total or intracellular Ca2+. The total and intracellular Ca2+ was still significantly higher than previously observed after 6 to 9 months of aortic stenosis. These results suggest that digoxin treatment not only tended to prevent further deterioration of cardiac function but also tended to prevent further changes in the sarcolemmal ATPase and electrolytes.

Topics: Adenosine Triphosphatases; Animals; Aortic Valve Stenosis; Digoxin; Dogs; Electrolytes; Extracellular Space; Heart Failure; Hemodynamics; Myocardial Contraction; Myocardium

This study shows significant changes occurring in systolic time intervals in an experimental animal model of aortic outflow obstruction with cardiac hypertrophy. The left ventricular ejection time is markedly prolonged and the preejection period/left ventricular ejection time ratio shortened. These changes are in the opposite direction of those usually observed with left ventricular dysfunction in man but similar to those described in man with aortic stenosis. Furthermore, the changes observed in systolic time intervals after digoxin in this experimental model are not comparable to those reported in man with normal or abnormal left ventricular function. Hence, the use of systolic time intervals, including digitalis effect, to evaluate the functional state of the left ventricle in aortic outflow obstruction are probably unreliable.

Topics: Animals; Aortic Valve Stenosis; Cardiomegaly; Digoxin; Heart Ventricles; Hemodynamics; Myocardial Contraction; Rabbits; Systole

Topics: Adult; Aged; Aortic Valve; Aortic Valve Stenosis; Digoxin; Female; Furosemide; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Prognosis; Radiography

Quinidine causes an increase in the serum digoxin concentration. Three patients were studied to determine if the increase in serum concentration is paralleled by an increase in the cardiac effect of digoxin. Each patient's clinical condition and serum digoxin concentration were stable when quinidine administration was begun. In all three patients, serum digoxin concentrations increased significantly after beginning quinidine, and decreased when quinidine was discontinued. While taking quinidine, all three patients had ECG findings that suggested enhanced digitalis effect and one patient had clinical evidence of an increased hemodynamic effect. These effects paralleled the increases in serum digoxin concentration. Our findings suggest that the increase in serum digoxin concentration, which occurs after beginning quinidine, is associated with an increase in the effect of digoxin on the heart.

Topics: Aged; Aortic Valve Stenosis; Arrhythmias, Cardiac; Digoxin; Drug Synergism; Female; Heart; Hemodynamics; Humans; Male; Middle Aged; Quinidine

22 patients with syncope and significant aortic stenosis underwent electrophysiological evaluation in addition to the hemodynamic study. Abnormalities of impulse formation or conduction were present in 12 patients. 6 patients demonstrated HV times greater than or equal to 55 msec. There was no correlation between the aortic valve gradient and the HV interval, between the enddiastolic volume of the ventricle and the HV time and between aortic valve calcification and the HV time. Syncopal attacks were corrected with aortic valve replacement even in patients with prolonged HV times.

Topics: Adult; Aged; Aortic Valve; Aortic Valve Stenosis; Bundle of His; Bundle-Branch Block; Calcinosis; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Middle Aged; Pacemaker, Artificial; Recurrence; Syncope

Topics: Animals; Aortic Valve Stenosis; Cardiomegaly; Deslanoside; Digitalis Glycosides; Digitoxin; Digoxin; Male; Medigoxin; Rats

Topics: Aortic Valve Stenosis; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Cardiomyopathies; Coronary Disease; Digoxin; Electrocardiography; Heart; Heart Ventricles; Humans; Hypertension; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Pulmonary Heart Disease; Time Factors

Topics: Administration, Oral; Adolescent; Adult; Age Factors; Aortic Valve Stenosis; Child; Child, Preschool; Digitalis Glycosides; Digoxin; Heart Defects, Congenital; Heart Septal Defects; Humans; Infant; Injections, Intramuscular; Poisoning; Radioimmunoassay; Tritium

Topics: Adult; Age Factors; Aortic Valve Stenosis; Body Water; Chlorides; Cytoplasm; Digoxin; Diuretics; Extracellular Space; Female; Heart Valve Diseases; Humans; Magnesium; Male; Middle Aged; Mitral Valve Stenosis; Muscles; Potassium; Radioisotopes; Sex Factors; Sodium; Spironolactone; Water-Electrolyte Balance

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

Topics: Aged; Anemia, Hemolytic; Aortic Valve Stenosis; Blood Cell Count; Digoxin; Diuretics; Female; Hemoglobinometry; Humans

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

Topics: Aortic Coarctation; Aortic Valve Stenosis; Child, Preschool; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Pulmonary Valve Stenosis; Transposition of Great Vessels

Topics: Aortic Valve Stenosis; Blood Pressure; Brachial Artery; Cardiac Catheterization; Digoxin; Electrocardiography; Fluoroscopy; Humans; Male; Middle Aged; Pulse

Topics: Aortic Valve Stenosis; Blood Circulation; Blood Flow Velocity; Blood Pressure; Cardiac Catheterization; Digoxin; Heart Failure; Heart Function Tests; Heart Valve Diseases; Humans; Hypertension; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pharmacology; Pulmonary Circulation

Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiac Surgical Procedures; Digoxin; Endocarditis; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heart, Artificial; Humans; Isoproterenol; Methicillin; Middle Aged; Postoperative Complications; Psychoses, Substance-Induced; Psychotic Disorders; Thoracic Surgery; Warfarin