digoxin and Cardiomegaly

Foetal echocardiography has progressed to be able to diagnose many forms of CHD and to assess the prognosis of cardiac lesions based on their anatomy and presentation in utero. This article outlines a straightforward method for the rapid evaluation of foetus that may have congestive heart failure with or without hydrops and for the differentiation of the pre-hydropic state from normal. The presence of signs of foetal heart failure, such as cardiomegaly or valvular regurgitation, gives clues to the aetiology of hydrops. The assessment of the prognosis of hydrops foetalis can be difficult but can be aided by the use of the cardiovascular profile score. Once identified, the neurohumoral effects of foetal heart failure can be ameliorated using transplacental digoxin if the hydrops has not progressed.

Topics: Cardiomegaly; Cardiotonic Agents; Digoxin; Echocardiography, Doppler, Color; Female; Fetal Heart; Heart Failure; Humans; Hydrops Fetalis; Pregnancy; Prognosis; Ultrasonography, Prenatal

Endoxin is a factor with a digitalis-like biological activity. It is a Na+ pump inhibitor and may be an endogenous medium of digitalis receptor. There are abnormal plasma levels of endoxin in some pathophysiologic states such as hypertension, acute myocardial infarction, arrhythmia, heart failure, etc. Some studies have demonstrated that the abnormal endoxin levels may be implicated in pathogenesis of these diseases or pathophysiologic process involved. Therefore, to clarify the effects of endoxin has much significance in understanding pathogenesis, prevention and treatment of hypertension and other cardiovascular diseases.

Topics: Animals; Cardenolides; Cardiomegaly; Cardiovascular System; Diabetes Mellitus; Digoxin; Enzyme Inhibitors; Heart Diseases; Heart Failure; Humans; Hypertension; Myocardial Infarction; Pulmonary Heart Disease; Saponins; Sodium-Potassium-Exchanging ATPase

Topics: Adrenal Cortex; Animals; Atrial Natriuretic Factor; Blood Proteins; Cardiomegaly; Cardiotonic Agents; Chickens; Digoxin; Dogs; Guinea Pigs; Heart Atria; Humans; Hydroxysteroids; Hypertension; Hypothalamus; Kidney; Muscle Proteins; Natriuretic Agents; Proteins; Rabbits; Rats; Sheep; Sodium; Sodium-Potassium-Exchanging ATPase; Vasodilation

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

The effects of captopril and digoxin treatment on left ventricular remodeling and function after anterior myocardial infarction were evaluated in a randomized unblinded trial. Fifty-two patients with a first transmural anterior myocardial infarction and a radionuclide left ventricular ejection fraction less than 40% were randomly assigned to treatment with captopril (Group A) or digoxin (Group B). The two groups had similar baseline hemodynamic, coronary angiographic, echocardiographic and radionuclide angiographic variables. Among the 40 patients (20 in each group) who were followed up for 1 year, echocardiographic end-diastolic and end-systolic volumes were unmodified in Group A and global wall motion index was improved (p less than 0.01); in Group B, end-diastolic and end-systolic volumes increased (p less than 0.001 for both) and global wall motion index was unchanged. Rest radionuclide ejection fraction increased significantly in both groups (p less than 0.001, Group A; p less than 0.005, Group B). A comparison of the changes in the considered variables between the two groups after 1 year of treatment showed a difference in end-diastolic (p less than 0.005) end-systolic volumes (p less than 0.001) and global wall motion index (p less than 0.005) without differences in radionuclide ejection fraction, which improved to a similar degree in both groups. The results of this study suggest that captopril therapy, started 7 to 10 days after symptom onset in patients with anterior myocardial infarction and an ejection fraction less than 40%, improves both left ventricular remodeling and function and prevents left ventricular enlargement and in these patients performs better than digitalis.

Topics: Captopril; Cardiomegaly; Digoxin; Echocardiography; Female; Follow-Up Studies; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Time Factors; Ventricular Function, Left

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.

Topics: Adult; Aged; Atrial Fibrillation; Cardiomegaly; Clinical Trials as Topic; Digitalis; Digitoxin; Digoxin; Female; Heart Rate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Renal Dialysis; Tachycardia; Time Factors

The effects of maintenance oral digoxin therapy on segmental left ventricular wall motion (wall motion videotracking) and left heart size (radiographic left heart dimension) were evaluated in 14 patients with a prior myocardial infarction but without clinical signs or symptoms of congestive heart failure. The left heart dimension decreased in all six patients with cardiomegaly from an average of 55.0 +/- 1.6 (standard deviation) to 52.2 +/- 2.7 mm/m2 body surface area (P less than 0.01) during digoxin therapy. However, there was no significant change in the eight patients with normal heart size. In the resting state, the average extent of shortening in normal segments increased significantly from 3.1 +/- 0.8 to 4.2 +/- 1.2 mm during digoxin therapy. During submaximal handgrip exercise, the extent of shortening averaged 4.0 +/- 1.3 mm and increased further with digoxin therapy to 5.1 +/- 2.1 mm. The effects of digoxin therapy on the maximal velocity of shortening in normal segments at rest and during handgrip exercise were similar. In all 14 patients, there was a decrease in the number of segments with abnormal wall motion at rest or with handgrip exercise during digoxin therapy. With therapy, the number of abnormal sites decreased from 52 to 35 in the resting state and from 84 to 49 during handgrip exercise. Thus, in patients 6 or more months after transmural myocardial infarction, orally administered digoxin decreases cardiomegaly, increases the extent and maximal velocity of shortening in normal left ventricular segments and often reduces the extent of abnormal wall motion at rest or during isometric exercise.

Topics: Administration, Oral; Adult; Aged; Blood Pressure; Cardiomegaly; Clinical Trials as Topic; Digoxin; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Physical Exertion

Cardiotonic drugs and exercise training promote cardiac inotropic effects, which may affect training-induced cardiac adaptations. This study investigated the effects of long-term administration of digoxin on heart structure and function, and physical performance of rats submitted to high-intensity interval training (HIIT). Male Wistar rats, 60 days old, were divided into control (C), digoxin (DIGO), trained (T), and trained with digoxin (TDIGO). Digoxin was administered by gavage (30 µg/kg/day) for 75 days. The HIIT program consisted of treadmill running 60 min/day (8 min at 80% of the maximum speed (MS) and 2 min at 20% of the MS), 5 days per week during 60 days. The main cardiac parameters were evaluated by echocardiograph and cardiomyocyte area was determined by histology. There were no group x time effects of digoxin, HIIT or interactions (digoxin and HIIT) on functional echocardiographic parameters (heart rate; ejection fraction) or in the maximum exercise test. There was a group x time interaction, as evidenced by observed cardiac hypertrophy in the TDIGO group evaluated by ratio of left ventricle weight to body weight (p<0.002) and cardiomyocyte area (p<0.000002). Long-term administration of digoxin promoted cardiac hypertrophy without affecting cardiac function and physical performance in rats submitted to HIIT.

Topics: Animals; Cardiomegaly; Digoxin; Echocardiography; Exercise Test; Heart; Heart Rate; High-Intensity Interval Training; Male; Physical Conditioning, Animal; Random Allocation; Rats; Rats, Wistar

Cardiac glycosides induce cardiomyocyte hypertrophy via yet to be defined mechanisms. These hypertrophic effects are likely related to changes in intracellular signalling secondary to Na(+)-K(+) ATPase (NKA) inhibition which would produce elevations in intracellular sodium concentrations. Sodium-hydrogen exchanger isoform 1 (NHE-1) also contributes to intracellular sodium regulation. Accordingly, we determined the contribution of NHE-1 to cardiac glycoside-induced hypertrophy.. The majority of the experiments were performed on cultured neonatal rat ventricular myocytes exposed to either ouabain (100 microM) or digoxin (40 microM) for 24 h, although additional experiments were also done using adult left ventricular myocytes with 30 microM of either glycoside. Both glycosides increased cell surface area by 30% and atrial natriuretic peptide gene expression by two- to three-fold (P < 0.05 for both). These effects were associated with a significant reduction in the expression of two NKA isoforms, alpha(2) and alpha(3), whereas the alpha(1) isoform was unaffected. Conversely, both glycosides increased NHE-1 expression in cardiomyocytes by approximately two-fold and significantly increased intracellular sodium concentrations by more than 60% (P < 0.05). Both ouabain and digoxin were also found to significantly increase phosphorylation of mitogen-activated protein kinases. All these effect were prevented when identical experiments were carried out in the presence of the NHE-1 inhibitors EMD 87580 or AVE 4890. Identical results were obtained using adult myocytes, although this was associated with downregulation of all three NKA isoforms. Glycoside-induced increase in cell shortening or intracellular Ca(2+) transients was not significantly affected by NHE-1 inhibition.. When taken together, these studies show that NHE-1 inhibition attenuates the hypertrophic effect of cardiac glycosides without affecting inotropic parameters and suggest a possible approach to limiting glycoside-induced hypertrophic responses while preserving therapeutic, i.e. inotropic, actions.

Topics: Animals; Cardiac Glycosides; Cardiomegaly; Digoxin; Heart Ventricles; Mitogen-Activated Protein Kinases; Myocardial Contraction; Myocytes, Cardiac; Ouabain; Rats; Rats, Sprague-Dawley; Sodium; Sodium-Hydrogen Exchangers; Sodium-Potassium-Exchanging ATPase

Topics: Adrenergic beta-Antagonists; Cardiomegaly; Digoxin; Diuretics; Female; Heart Atria; Humans; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Tomography, X-Ray Computed; Ultrasonography; Warfarin

Topics: Adult; Anti-Arrhythmia Agents; Cardiomegaly; Digoxin; Fatal Outcome; Female; Heart Defects, Congenital; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Ultrasonography, Prenatal

In our referral center, 14,481 fetal echocardiography examinations were performed in 10,077 fetuses, in years 1994-2006. Fifty four fetuses presented cardiomegaly HA/CA > 0.6. There was one single survivor whose medical history is presented. Fetal cardiomegaly was detected by obstetrical ultrasound screening. In tertiary center HA/CA was evaluated as the following: 0.5 at 32 wks and 0.65 at 36 wks. In addition to cardiomegaly, pulmonary stenosis/atresia, dysplastic tricuspid valve with massive regurgitation were diagnosed. Digoxin was administered transplacentally for 33 days and, additionally, 30 min. oxygen was provided by mask for pregnant woman, 3 times per day. Spontaneous labour took place at 38 wks, with 3100 birth weight and 9 Apgar score. The newborn baby had only temporary tachypnoe, had a planned postdelivery therapy including prostin and cardiacsurgery and was discharged home at the age of 4 weeks in a good clinical condition. This is the first case in our institution of such massive cardiomegaly who did survived the neonatal period. The possible beneficial effects of transplacental digoxin and oxygen therapy are discussed, as well as fetal echocardiography monitoring using HA/CA and pulmonary venous Doppler flow.

Topics: Adult; Cardiomegaly; Cardiotonic Agents; Digoxin; Drug Administration Routes; Echocardiography, Doppler; Female; Fetal Diseases; Fetal Heart; Gestational Age; Humans; Lung; Oxygen; Pregnancy; Pulmonary Atresia; Pulmonary Valve Stenosis; Tricuspid Valve Insufficiency; Ultrasonography, Prenatal

We sought to evaluate the relationships among circulating levels of an endogenous ouabain-like factor (EO) and systemic hemodynamics and left ventricular (LV) geometry in patients with recently diagnosed essential hypertension. We selected 92 never-treated patients with essential hypertension. Blood samples were drawn for estimation of plasma EO (radioimmunoassay) and subjects underwent echocardiographic examination to evaluate LV end-systolic and end-diastolic wall thickness and internal dimensions. LV volumes, stroke volume, cardiac output, total peripheral resistance, LV mass, and relative wall thickness were calculated, and all except the last parameter were indexed by body surface area. LV mass also was indexed by height. On the basis of the values of LV mass index (body surface area or height) and relative wall thickness, subjects were divided into groups with either normal geometry, concentric remodeling, concentric hypertrophy, or eccentric nondilated hypertrophy. In the study population as a whole, circulating EO levels were significantly and directly correlated with mean blood pressure (r = 0.21, P = .048), relative wall thickness (r = 0.34, P = .001), and total peripheral resistance index (r = 0.37, P = .0003). Plasma EO also was significantly and inversely correlated with LV end-diastolic volume index (r = -0.32, P = .002), stroke index (r = -0.34, P = .0009), and cardiac index (r = -0.35, P = .0007). In multiple regression analysis, plasma EO was an independent correlate of total peripheral resistance index, cardiac index, and relative wall thickness. Regardless of the indexation method used for LV mass, plasma EO was higher in patients with concentric remodeling than in those with either normal geometry or concentric hypertrophy. Plasma EO tended to be higher (indexation by body surface area) or was significantly higher (indexation by height) in subjects with concentric remodeling than in those with eccentric nondilated hypertrophy. Patients with concentric remodeling showed the highest total peripheral resistance index and the lowest cardiac index. Our data suggest that EO plays a role in regulating systemic hemodynamics and LV geometry in patients with essential hypertension.

Topics: Adult; Biological Factors; Cardenolides; Cardiomegaly; Digoxin; Echocardiography; Female; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Saponins; Ventricular Function, Left; Ventricular Remodeling

Treatment with the angiotensin-converting enzyme inhibitor, quinapril, has been shown to normalize increased dihydropyridine sensitivity and impaired potassium relaxation, characteristic features of arterial smooth muscle in spontaneously hypertensive rats, and also reduce the concentration of plasma digoxin-like immunoreactivity in these animals. However, whether angiotensin II receptor blocker therapy can beneficially influence these variables is not known. Therefore, we compared the effects of 10-week losartan and enalapril treatments (15 and 4 mg/kg/day, respectively) on functional responses of mesenteric arterial rings in spontaneously hypertensive rats and Wistar-Kyoto rats. Both losartan and enalapril normalized blood pressure, cardiac mass, and media to lumen ratio without significantly changing the media cross-sectional area in the mesenteric artery of spontaneously hypertensive rats (i.e. induced outward remodelling). The inhibitory effect of the calcium entry blocker nifedipine on calcium-evoked contractions was similar and less marked in arterial preparations from Wistar-Kyoto rats and losartan- and enalapril-treated spontaneously hypertensive rats than in those from untreated spontaneously hypertensive rats. Furthermore, the relaxations of arterial rings induced by the return of potassium to the organ bath (upon precontractions elicited by potassium-free solution) were used to evaluate the function of vascular Na+,K+-ATPase. The rate of potassium relaxation was faster in losartan- and enalapril-treated spontaneously hypertensive rats and all Wistar-Kyoto groups than in untreated spontaneously hypertensive rats, and the response was effectively inhibited by the sodium pump inhibitor ouabain. Both treatments especially augmented the ouabain-sensitive part of the potassium-relaxation in spontaneously hypertensive rats, indicating the involvement of the sodium pump in this response. However, no significant changes in plasma digoxin-like immunoreactivity were observed. In conclusion, the outward remodelling following long-term AT1-receptor blockade and angiotensin-converting enzyme inhibition in spontaneously hypertensive rats was associated with normalization of the increased dihydropyridine sensitivity of arteries. Both losartan and enalapril treatments also augmented arterial potassium relaxation in spontaneously hypertensive rats, suggesting enhanced function of Na+,K+-ATPase, but this effect could not be attributed to changes in circulating s

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Antihypertensive Agents; Blood Pressure; Body Weight; Cardiomegaly; Digoxin; Dihydropyridines; Enalapril; Heart; Hypertension; Losartan; Male; Mesenteric Arteries; Muscle, Smooth, Vascular; Nifedipine; Organ Size; Potassium Chloride; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Receptor, Angiotensin, Type 1; Receptor, Angiotensin, Type 2; Sodium-Potassium-Exchanging ATPase; Tunica Media

Peripatum cardiomyopathy is a rare disease, which appears as cardiac failure, at the end of pregnancy and puerperium without an apparent cause. The diagnosis is done clinically based in accepted criteria by Demakis, and it is confirmed by auxiliary tests. Treatment includes rest, digitalic and diuretic medications. Prognosis is bad when there is not symptomatic regression, with a high mortality soon after. The experience at Hospital Central Militar from 1967 to 1995, is presented. There were nine cases, two of which had died; and the presentation of the last case, is done herein.

Topics: Adult; Cardiomegaly; Cardiomyopathies; Cesarean Section; Digoxin; Elective Surgical Procedures; Female; Heart Failure; Hospitals, Military; Humans; Mexico; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Edema; Ultrasonography, Prenatal

The literature was reviewed for evidence of digoxin efficacy and for indicators of positive digoxin response in chronic congestive heart failure with normal sinus rhythm. Practice in a family medicine teaching unit was audited based on this review. Most patients in this study were treated appropriately. Several (22% to 36%), however, were treated incorrectly with digoxin.

Topics: Aged; Cardiomegaly; Digoxin; Drug Utilization Review; Family Practice; Female; Heart Failure; Heart Rate; Heart Sounds; Hospital Units; Hospitals, General; Hospitals, Teaching; Humans; Male; Medical Audit; Quebec; Retrospective Studies; Severity of Illness Index

Topics: Adult; Captopril; Cardiomegaly; Cesarean Section; Critical Care; Digoxin; Dobutamine; Dopamine; Female; Furosemide; Heart Failure; Heparin; Humans; Potassium; Pregnancy; Pregnancy Complications, Cardiovascular

Because global T wave inversion has not been specifically characterized, 100 electrocardiograms (ECGs) with this pattern (frontal plane T vector -100 degrees to -170 degrees with precordial T inversion) were prospectively collected from approximately 30,000 consecutively interpreted ECGs and analyzed blindly. There was a striking female predominance (82 women vs. 18 men; p less than 0.0005) despite an essentially equal number of female and male hospital admissions. There was a single statistically significant ECG correlate: a more vertical QRS axis in women (+14.1 degrees +/- 45.3 degrees vs. -5.6 degrees +/- 31.3 degrees; p = 0.034). The T waves were basically symmetric (68%), the influence of this factor usually altering the characteristically asymmetric T wave inversions of right bundle branch block (4 of 5) and left ventricular hypertrophy (21 of 36). Asymmetry was mainly associated with digoxin therapy (21 of 32 patients taking digoxin; p less than or equal to 0.0005) and a corrected QT (QTc) interval (0.433 +/- 0.095) shorter than with symmetric T wave inversions (0.507 +/- 0.074; p less than or equal to 0.0005) though not reaching the degree of shortening expected for digitalization. Twenty-eight patients admitted for acute myocardial infarction and 23 for a central nervous system disorder accounted for the majority of patients with symmetric T wave inversion. Fifteen of 18 patients who had coronary angiography had some degree of coronary artery disease: 3 had angiographically normal coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Age Factors; Bundle-Branch Block; Cardiomegaly; Central Nervous System Diseases; Digoxin; Electrocardiography; Female; Gastrointestinal Diseases; Heart; Humans; Lung Diseases; Male; Metabolic Diseases; Myocardial Infarction; Sex Factors

Topics: Adult; Anthropometry; Cardiomegaly; Digoxin; Furosemide; Humans; Male; Marfan Syndrome

Topics: Aged; Aged, 80 and over; Cardiomegaly; Digoxin; Electrocardiography; Emergencies; Equipment Failure; Female; Heart Failure; Humans; Pacemaker, Artificial; Radiography

Although exercise-induced ST segment depression is thought to be unreliable marker of myocardial ischemia in the presence of resting electrocardiographic changes, this conclusion is based on limited and disparate data from studies often lacking acceptable measures of ischemia. To determine the diagnostic accuracy of the ST segment response in a blinded prospective protocol, we compared ST deviation to thallium201 SPECT scintigraphy in 95 patients during exercise. Diagnostic accuracy was poor in the 95 patients with resting abnormalities: left bundle branch block (LBBB) = 70%, complete right bundle branch block (cRBBB) = 75%, incomplete right bundle branch block (incRBBB) = 79%, intraventricular conduction delay (IVCD) = 44%, left ventricular hypertrophy (LVH) = 59%, digitalis = 53%, compared with a diagnostic accuracy of 90% in 29 patients without resting changes. There were 20 false negative and 17 false positive ST segment responses. The extent and direction of resting ST deviation varied substantially and had no influence on diagnostic accuracy. The extent of change in ST deviation with exercise required for a positive response did not alter diagnostic accuracy: -1.0 mm = 61%, -1.5 mm = 63%, and -2.0 = 61%. While the location of regional ischemia did not influence the accuracy of ST segment analysis, a QRS duration less than 120 msec did improve diagnostic accuracy. Our data confirm that ST segment analysis with exercise testing is not reliable in patients with resting electrocardiographic abnormalities and demonstrates that accuracy is not improved by adjusting for either resting or exercise-induced ST segment changes or for location of the ischemic region.

Topics: Aged; Angiography; Bundle-Branch Block; Cardiomegaly; Coronary Angiography; Coronary Disease; Digoxin; Electrocardiography; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Rest; Tomography, Emission-Computed, Single-Photon

Topics: Animals; Cardiomegaly; Cell Membrane; Digoxin; Male; Myocardium; Rats; Rats, Inbred Strains; Receptors, Drug; Sodium-Potassium-Exchanging ATPase; Thyrotoxicosis

A 9-year-old male with myocarditis is described. A greater than four-fold rise in titers against rubella with a subsequent fall supports the conclusion that his myocarditis was associated with rubella infection. Other than neonates, rubella myocarditis has been reported previously in only six patients, one of whom was a child.

Topics: Adrenal Cortex Hormones; Cardiomegaly; Child; Digoxin; Humans; Male; Myocarditis; Penicillins; Rubella

To assess the effect of oral digoxin on left ventricular systolic function in elderly patients, radionuclide angiography was performed on 20 patients 74 years old or older before and after several weeks of oral digoxin. The mean age was 83.8 years. All had congestive heart failure or cardiomegaly, and all were in sinus rhythm. The ejection fraction was 0.36 +/- 0.10 (mean +/- SD) before digoxin; 0.45 +/- 0.09 after digoxin (P less than 0.01). A comparison group that did not receive digoxin had no significant improvement in ejection fraction. In ten patients serial radionuclide angiograms were repeated after increasing serum digoxin concentrations. Six demonstrated maximal improvement in ejection fraction at serum digoxin concentrations of 0.4-1.0 ng/ml. It is concluded that oral digoxin improves left ventricular ejection fraction in elderly patients with congestive heart failure or cardiomegaly who are in sinus rhythm. Some of these patients achieve maximal improvement in ejection fraction at serum digoxin concentrations of less than 1.0 ng/ml.

Topics: Administration, Oral; Age Factors; Aged; Cardiac Output; Cardiomegaly; Digoxin; Heart Failure; Humans; Radionuclide Imaging; Stroke Volume

Clinical and electrocardiographic manifestations of congestive cardiomyopathy are considered on the basis of observations of 25 patients with this pathology of the myocardium. No clinico-electrocardiographic signs specific for this disease were found. Most characteristic were cardiomegaly, congestive cardiac failure and various disturbances of rhythm and conductivity. Thromboembolic complications in the lung and kidney vessels are frequently found. Cardiac glycosides, saluretics and vasodilators were employed in the treatment of patients with congestive cardiomyopathy but the prognosis was usually poor.

Topics: Adolescent; Adult; Cardiomegaly; Cardiomyopathy, Dilated; Coronary Disease; Diagnosis, Differential; Digoxin; Drug Therapy, Combination; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Nitroglycerin; Strophanthins

Under conditions of experimental cardiac overload and hypertrophy in rats, a digoxinlike immunoreactivity appears in their serum which is correlated with cardiac growth. It is hypothesized that this is caused by the presence of an endogenous cardiotropic factor displaying cross immunoreactivity with digoxin. Additional evidence of the existence of the putative cardiotropic factor is provided by the finding that the sera of rats with cardiac overload displaying digoxinlike immunoreactivity stimulate the multiplication of rat cardiac myocytes in the tissue culture. This factor may be an adrenal steroid different from corticosterone and aldosterone. The name endocardin or endocardiotonin for this substance is suggested.

Topics: Adrenal Glands; Animals; Cardiomegaly; Digitoxin; Digoxin; Heart; Male; Organ Size; Rats; Rats, Inbred Strains

Congestive heart failure has never been described in patients with dysplastic stenotic pulmonary valve without associated shunt lesions. We describe two patients with mild pulmonic stenosis due to valvular dysplasia associated with cardiomyopathy who developed severe congestive heart failure. Since the small pressure gradients across the pulmonary valve cannot cause this complication, we suggest that it resulted from the associated hypertrophic non-obstructive cardiomyopathy. The presence of cardiomyopathy may alter the clinical presentation and prognosis of patients with dysplastic pulmonary valve. In some cases, like our two cases, the cardiomyopathy rather than the valvular lesion should be considered the main disease.

Topics: Cardiomegaly; Cardiomyopathies; Digoxin; Heart Failure; Humans; Infant; Infant, Newborn; Male; Pulmonary Valve; Pulmonary Valve Stenosis; Radiography

The acute and chronic compensatory mechanisms underlying the clinical syndrome of heart failure are summarised. Problems of diagnosing heart failure and causes of heart failure, particularly in the elderly, are noted, against a framework of reference of the determinants of cardiac output. The main approaches to treating heart failure are reviewed against the same framework of reference.

Topics: Aged; Cardiac Output; Cardiomegaly; Digoxin; Diuretics; Heart Failure; Humans; Vasodilator Agents

Although most cases of sustained atrial fibrillation are associated with mitral valve disease, hypertension, cardiac failure and atherosclerotic heart disease, some cases occur in the absence of any identifiable organic pathology. The consequences of atrial fibrillation include reduction in cardiac output, systemic emboli and an exaggerated ventricular response to exercise. In most clinical situations, digoxin is the drug of choice for controlling the ventricular response. Cardioversion should be undertaken in appropriately selected patients.

Topics: Age Factors; Aged; Atrial Fibrillation; Cardiomegaly; Digoxin; Electric Countershock; Electrocardiography; Heart Failure; Humans; Hypertension; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Verapamil

Topics: Adult; Blood Pressure; Cardiomegaly; Cardiomyopathies; Digoxin; Echocardiography; Exercise Test; Heart Rate; Hemodynamics; Humans; Male; Myocardial Contraction; Stimulation, Chemical

Topics: Cardiomegaly; Digoxin; Humans; Immunoenzyme Techniques; Sodium-Potassium-Exchanging ATPase

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: Adrenal Glands; Animals; Aorta; Biological Products; Cardiomegaly; Cardiotonic Agents; Digitoxin; Digoxin; Heart; Heart Ventricles; Ligation; Male; Organ Size; Rats

We monitored, by the Holter method, 23 clinically stable maintenance hemodialysis patients for 5 +/- (SEM) 2 hours before hemodialysis, 5.0 +/- 0.5 hours during hemodialysis, and 13 +/- 3 hours after hemodialysis. Of 23 patients, 9 (39%) had unexpected frequent or complex ventricular arrhythmias recorded and after hemodialysis with a potassium dialysate bath concentration of 2.0 mEq/liter. Patients with ventricular arrhythmias were more likely to be using digoxin (8/9 vs. 1/4) and to have evidence of left ventricular hypertrophy (9/9 vs. 7/4 than were those patients without arrhythmias. Of these 9 patients with arrhythmias, 6 underwent repeat Holter monitoring during multiple dialysate protocols. Of the 6 patients, 4 had a significant reduction in the frequency of ventricular ectopy when a dialysate of 3.5 mEq/liter potassium was used (P < 0.05), but of these 6, 3 still had complex arrhythmias. The use, however, of a 3.5 mEq/liter potassium dialysate plus the administration of a 400-mg dose of quinidine sulfate orally 45 min prior to hemodialysis was successful in reducing ventricular ectopic frequency and complexity in all the patients studied. Conclusion. Maintenance hemodialysis patient using digoxin and with left ventricular hypertrophy have an unexpectdly high indicence of occult, potentoial serious, ventricular arrhythmias during and after hemodialysis, revealed by Holter monitoring. There is preliminary evidence that a low-potassium bath concentration may play a role in predisoposing patients to these arrhythmias. Further prospective studies with largaer number of patients will be needed, however, to evaluate the significance of these findings.

Topics: Adult; Aged; Arrhythmias, Cardiac; Cardiomegaly; Digoxin; Electrolytes; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Potassium; Prospective Studies; Renal Dialysis

Topics: Animals; Biological Products; Cardiomegaly; Digoxin; Male; Rats

Topics: Animals; Cardiomegaly; Digoxin; Hyperthyroidism; Immunoenzyme Techniques; Male; Rats

Topics: Animals; Antigen-Antibody Reactions; Cardiomegaly; Digoxin; Heart; Hyperthyroidism; Male; Organ Size; Rats; Spironolactone; Thyroxine

Two hundred consecutive catheterized patients with unstable angina pectoris were reviewed to find clinical and noninvasive indicators of left main coronary artery disease (greater than or equal to 50% lesion). Thirty-five patients (17.5% of total) had left main coronary artery disease. There were no differences between patients with and without left main coronary artery disease in age, sex, results of resting electrocardiogram, congestive heart failure, dyspnea during pain, duration of longest pain, arrhythmias, response to medical therapy, or other risk factors. Crescendo angina pectoris (worsening of pre-existing angina), transient ST-segment depression with pain, simultaneous anterior and inferior ST changes during pain, and fluoroscopic calcification of the left main coronary artery were all significantly more common in patients with left main coronary artery disease. However, low sensitivity or low predictive value, or both, limit the usefulness of these clinical predictors. Left main coronary artery disease cannot be reliably predicted in patients with unstable angina pectoris before coronary arteriography.

Topics: Angina Pectoris; Angiography; Anticoagulants; Calcinosis; Cardiac Catheterization; Cardiomegaly; Collateral Circulation; Coronary Angiography; Coronary Circulation; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Male; Middle Aged; Nitrates; Propranolol; Risk

Topics: Adult; Antihypertensive Agents; Cardiomegaly; Digoxin; Drug Therapy, Combination; Female; Furosemide; Humans; Hydralazine; Hypertension, Malignant; Hypertension, Renal; Kidney Diseases; Methyldopa; Minoxidil; Propranolol; Scleroderma, Systemic; Time Factors

Six examples of intrauterine supraventricular tachycardia together with 31 previously reported cases are described and analyzed. Among the 37 infants, structural heart disease was present in only four (11%), three of whom died. Males comprised 68% of the group without identifiable heart disease or pre-excitation. Congestive heart failure was evident in 62% of the infants at birth or shortly thereafter; ascites was the predominant finding in three (8%). Neither the duration of SVT nor heart rate was predictive of the clinical status at birth. Infants without underlying heart disease or conduction abnormalities had a benign course after the neonatal period. Thirty-eight percent of the babies converted to sinus rhythm during or shortly after delivery without medication, and most of the others converted after digitalization. The failure of maternal digitalization to convert SVT to sinus rhythm in two of our infants was perhaps related to subtherapeutic maternal and fetal digoxin levels. Newborn infants presenting with unexplained ascites or congestive heart failure should have an ECG to determine whether pre-excitation is present, and their cardiac rhythm should be monitored for several days.

Topics: Ascites; Cardiomegaly; Digoxin; Female; Fetal Diseases; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

Cardiac muscle myosin ATPase activity is depressed and contractile function impaired when the heart is subjected to a chronic pressure overload. Administering digitalis in the presence of chronic pressure overload significantly attenuates the decline in mechanical function. The current study sought to determine if the cardiac muscle myosin ATPase activity of cats treated with digitalis in the presence of pressure overload remains normal in parallel with the mechanical function. Four groups of cats were studied: normal controls (C), animals with pressure-overload hypertrophy with or without failure (HF), normal cats that received treatment with digitalis (D), and animals that received digitalis prior to and together with pressure overload (DHF). Compared to C, the maximum myosin ATPase activity of HF was significantly (P less than 0.05) depressed, but the maximum ATPase activity of D and DHF was not altered significantly (P greater than 0.05) from C. In parallel with the enzyme maximum activity, the papillary muscle isometric rate of force development was significantly (P less than 0.005) depressed in HF compared to C; D and DHF were not significantly (P greater than 0.05) different from C. It is concluded that the depression of myosin ATPase observed in HF is not present when digitalis is administered concomitant with the pressure overload.

Topics: Adenosine Triphosphatases; Animals; Cardiomegaly; Cats; Digitalis Glycosides; Digoxin; Female; Heart; Heart Failure; Kinetics; Male; Myocardial Contraction; Myocardium; Myosins; Organ Size; Papillary Muscles; Pressure

Topics: Adolescent; Adrenal Cortex; Adult; Cardiomegaly; Catecholamines; Digoxin; Female; Humans; Male; Middle Aged; Myocarditis; Propranolol; Sympathetic Nervous System

Topics: Aged; Aminophylline; Atrial Flutter; Calcinosis; Cardiomegaly; Cefazolin; Digoxin; Heart Block; Humans; Male; Oxygen Inhalation Therapy; Pericarditis; Respiratory Insufficiency

Topics: Adolescent; Adult; Aged; Alcoholic Beverages; Benzothiadiazines; Blood Pressure; Cardiomegaly; Cardiomyopathies; Child; Diet; Digoxin; Diuretics; Female; Furosemide; Heart Failure; Humans; Hypertension; Male; Methyldopa; Middle Aged; Nigeria; Sodium Chloride Symporter Inhibitors

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

Nine children with endocardial fibroelastosis were followed from the time of admission with congestive heart failure until either death or discharge. Review of multiple clinical features showed that only the electrocardiographic pattern could be correlated with death or survival. The presence of a delayed transition zone with anterior force loss on the initial electrocardiogram ('infarct pattern') was noted in all the children who died. Progression of these changes with a pattern of anterolateral 'infarct' in two and inferior wall 'infarct' in two occurred before death. Necropsy on three of the four children confirmed the diagnosis of endocardial fibroelastosis. There was extensive fibrosis and thinning of the left ventricular myocardium as well as involvement of the mitral valve structures. Review of published cases supports the view that an 'infarct' pattern in a child with endocardial fibroelastosis is usually associated with death and that this pattern is a negative prognostic sign for survival.

Topics: Cardiomegaly; Child; Child, Preschool; Digoxin; Electrocardiography; Endocardial Fibroelastosis; Female; Follow-Up Studies; Heart Failure; Humans; Infant; Male; Myocardial Infarction; Prognosis

Topics: Animals; Cardiomegaly; Digitoxin; Digoxin; Hypoxia; Male; Rats

Topics: Adult; Cardiomegaly; Digoxin; Doxorubicin; Electrocardiography; Female; Heart; Heart Diseases; Heart Failure; Heart Function Tests; Heart Ventricles; Humans; Lymphoma; Male; Middle Aged; Multiple Myeloma; Neoplasms; Prospective Studies

Topics: Adult; Body Temperature; Cardiomegaly; Digoxin; Electrocardiography; Furosemide; Humans; Hydrocortisone; Male; Myocarditis; Pericarditis; Prednisone; Pulmonary Edema; Smallpox Vaccine

Topics: Animals; Calcium; Cardiomegaly; Creatinine; Digoxin; Dogs; Electrocardiography; Heart Ventricles; Hemoglobins; Infusions, Parenteral; Magnesium; Myocardium; Potassium; Pulmonary Valve Stenosis; Tritium; Urea

Topics: Arrhythmias, Cardiac; Carbon Dioxide; Cardiac Complexes, Premature; Cardiomegaly; Coronary Disease; Digoxin; Heart Failure; Heart Rate; Humans; Hypertension, Pulmonary; Male; Oxygen; Potassium; Pulmonary Heart Disease

Topics: Anticoagulants; Blood Pressure; Cardiac Catheterization; Cardiomegaly; Dietary Fats; Digoxin; Diuretics; Heart Septal Defects, Ventricular; Heart Septum; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Oxygen; Rupture; Venous Pressure

Topics: Angiocardiography; Cardiac Catheterization; Cardiomegaly; Digoxin; Electrocardiography; Extracorporeal Circulation; Female; Furosemide; Heart Auscultation; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Male; Oxygen Inhalation Therapy; Pulmonary Valve Stenosis; Pulmonary Veins; Respiratory Insufficiency

Topics: Adolescent; Adrenal Cortex Hormones; Brain Edema; Cardiomegaly; Central Venous Pressure; Cerebrovascular Circulation; Digoxin; Diuretics; Heart Arrest; Heart Atria; Heart Injuries; Hematoma; Humans; Male; Mediastinum; Oxygen Inhalation Therapy; Postoperative Complications; Radiography; Rupture; Thrombosis; Time Factors; Ventilators, Mechanical

Topics: Animals; Cardiomegaly; Cats; Digoxin; Electrocardiography; Heart; Heart Conduction System; Heart Failure; Humans; Sodium Chloride

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

Topics: Acidosis, Respiratory; Age Factors; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiomegaly; Cyanosis; Diagnosis, Differential; Digoxin; Dyspnea; Electrocardiography; Ethacrynic Acid; Heart Defects, Congenital; Heart Failure; Hemodynamics; Hepatomegaly; Humans; Infant; Infant Care; Infant, Newborn; Lung Diseases; Monitoring, Physiologic; Oxygen; Parenteral Nutrition; Radiography

Topics: Adenosine Triphosphatases; Animals; Cardiomegaly; Digoxin; Heart Diseases; Heart Ventricles; Kidney; Male; Microsomes; Myocardium; Ouabain; Plant Poisoning; Potassium; Rats; Sodium

Topics: Animals; Aorta; Aortography; Arteriovenous Fistula; Blood Pressure; Cardiomegaly; Catheterization; Digoxin; Dogs; Female; Femoral Artery; Heart Diseases; Heart Ventricles; Hypertension, Pulmonary; Male; Oxygen; Pulmonary Artery; Pulmonary Circulation; Regional Blood Flow

Topics: Adult; Aged; Cardiomegaly; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Hypertrophy; Male; Middle Aged; Mitral Valve Stenosis; Rheumatic Heart Disease; Vectorcardiography

Topics: Blood Pressure; Cardiac Catheterization; Cardiomegaly; Child; Child, Preschool; Digoxin; Diuresis; Female; Glomerulonephritis; Humans; Hypertension; Male; Nitrites; Pulmonary Artery

Topics: Angiocardiography; Bradycardia; Cardiomegaly; Digoxin; Electrocardiography; Female; Heart Block; Heart Septal Defects, Ventricular; Hepatomegaly; Humans; Hypertension, Pulmonary; Infant; Pacemaker, Artificial

Topics: Cardiomegaly; Digoxin; Geriatrics; Heart Failure; Heart Function Tests; Heart Rate; Humans; Pulse; Radiography, Thoracic; Respiration; Starvation

Topics: Angiocardiography; Cardiomegaly; Child; Coronary Vessel Anomalies; Diagnosis, Differential; Digitalis; Digoxin; Drug Therapy; Electrocardiography; Endocardial Fibroelastosis; Glycogen Storage Disease; Humans; Infant; Mumps; Myocarditis; Skin Tests

Topics: Acetylcholine; Blood Pressure; Blood Vessels; Cardiac Catheterization; Cardiomegaly; Digoxin; Familial Primary Pulmonary Hypertension; Humans; Hypertension; Hypertension, Pulmonary; Infusions, Parenteral; Lung; Lupus Erythematosus, Systemic; Metabolism; Prednisone; Pulmonary Heart Disease; Tolazoline

Topics: Cardiomegaly; Digoxin; Heart; Humans; Male