digoxin and Cardiomyopathies

Cardiomyopathy during pregnancy is uncommon but potentially catastrophic to maternal health, accounting for up to 11% of maternal deaths. Peripartum cardiomyopathy is diagnosed in women without a history of heart disease 1 month before delivery or within 5 months postpartum. About half of all women will have full myocardial recovery within 6 months of diagnosis, but complications such as severe heart failure or death are not rare. African-American women have higher rates of diagnosis and adverse events. Women with preexisting cardiomyopathy, such as dilated or hypertrophic cardiomyopathy, followed closely during pregnancy often tolerate pregnancy and delivery. Risk factors for adverse outcomes include functional status at baseline, severity of systolic dysfunction or outflow tract gradient, or history of prior cardiac event, such as arrhythmia or stroke. The level of brain natriuretic peptide (BNP) can be used to risk stratify women for adverse events. Pregnant women with cardiomyopathy should be followed closely by a multidisciplinary team comprised of nurses, obstetricians, neonatologists, cardiologists, anesthesiologists, and cardiac surgeons.

Topics: Adrenergic beta-Antagonists; Adult; Anesthesia, Obstetrical; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Cardiomyopathies; Contraindications; Digoxin; Diuretics; Female; Heart Failure; Humans; Incidence; Infant, Newborn; Maternal Age; Maternal Mortality; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy, High-Risk; Prognosis; Risk Factors; Spironolactone; Treatment Outcome

The present review will examine the prognostic importance of atrial fibrillation and heart failure, explore the different therapeutic options for treating atrial fibrillation and present the results of the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial.. The Atrial Fibrillation and Congestive Heart Failure trial was a randomized trial involving patients with both atrial fibrillation and heart failure. The trial was designed to compare the maintenance of sinus rhythm with the control of ventricular rate in patients with left ventricular dysfunction, heart failure and a history of atrial fibrillation. There was no significant difference in the rate of death from cardiovascular causes in the rhythm-control group as compared with the rate-control strategy. In addition, there was no significant difference in any of the secondary outcomes including death from any cause, worsening heart failure or stroke. The rate-control strategy eliminated the need for repeated cardioversion and reduced rates of hospitalization.. The results of the Atrial Fibrillation and Congestive Heart Failure trial indicate that a routine strategy of rhythm control does not reduce rate of death and suggest that rate control should be considered a primary approach for patients with atrial fibrillation and heart failure.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Catheter Ablation; Comorbidity; Digoxin; Heart Failure; Heart Rate; Humans; Randomized Controlled Trials as Topic; Tachycardia

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathies; Child; Child, Preschool; Digoxin; Forecasting; Heart Defects, Congenital; Heart Failure; Humans; Infant

Topics: Age Factors; Cardiomyopathies; Digoxin; Heart Failure; Oxygen Inhalation Therapy

Many investigators have studied the potential interactions between calcium-channel antagonists and digoxin. Digoxin is usually well absorbed, and its excretion is dependent on renal mechanisms, primarily glomerular filtration. Several studies have reported a decrease in digoxin clearance and an increase of approximately 50% in digoxin levels when verapamil was added to digoxin therapy. Because renal digoxin clearance was decreased but no concomitant change in creatinine clearance was shown, the presumed major mechanism for decreased renal digoxin clearance is an alteration in renal tubular secretion of digoxin. Although an early report described a digoxin-nifedipine interaction, several subsequent studies have shown no significant changes in digoxin kinetics during nifedipine administration. Four studies found no significant decrease in creatinine clearance of digoxin during nifedipine administration. Thus significant changes in glomerular filtration are unlikely. Physiologic endpoints were measured by 2 groups describing a digoxin-nifedipine interaction and, although there was an increase in serum digoxin concentration, no changes were found in electrophysiologic correlates. Thus, if a digoxin-nifedipine interaction does exist, steady-state digoxin levels might increase from 24 to 45% when nifedipine therapy is added. Studies to date have involved small numbers of subjects with and without cardiac disease and have used different study protocols. Nonetheless, little evidence exists for any clinically significant increase in physiologic effects and no adverse effects have been found in patients receiving combined nifedipine and digoxin.

Topics: Absorption; Administration, Oral; Cardiomyopathies; Digoxin; Drug Interactions; Electrophysiology; Glomerular Filtration Rate; Humans; Kinetics; Nifedipine

Topics: Adolescent; Captopril; Cardiomyopathies; Child; Digoxin; Dobutamine; Dopamine; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Furosemide; Heart; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hydralazine; Isoproterenol; Nitroprusside; Physical Examination; Radionuclide Imaging; Rheumatic Heart Disease

Topics: Animals; Cardiomyopathies; Cat Diseases; Cats; Diet, Sodium-Restricted; Digoxin; Electrocardiography; Furosemide; Heart Diseases; Heart Failure; Lidocaine; Propranolol; Thromboembolism

Antibodies to digitalis glycosides have been elicited in experimental animals and have been utilized in the development of rapid, sensitive, specific and convenient radioimmunoassay methods for the clinical measurement of digoxin and other cardiac glycosides in man. The use of these assay methods has supplemented earlier studies with radiolabeled digitalis preparations and has made it possible to obtain much new information concerning factors which may contribute to the well known patient to patient variability in digitalis dosage requirements and in sensitivity to the toxic effects of cardiac glycosides. In some patients with a poor clinical response to digitalis, the finding of a serum concentration which is relatively low for the dose prescribed may suggest that true digitalis resistance is not present and may raise questions of poor patient compliance, tablet inadequacies, intestinal malabsorption, increased metabolic degradation or hyperthyroidism; if the cause of the low serum level cannot be identified or corrected, serial serum measurements should enable safe and rational upward adjustment of dosage. In some patients with digitalis toxicity, the finding of a serum level which is relativity high for the dose prescribed may suggest that the patient is not sensitive to digitalis but rather is excreting it slowly; in such instances in elderly patients (with decreased glomerular filtration rates) and in patients with renal disease, serial digitalis measurements are useful adjuncts to clinical observation in determining optimal digitalis dosage schedules. A knowledge of serum digitalis concentrations should enable us to develop sound principles for a more rational approach to the clinical administration of cardiac glycosides, especially in patients with unusually high dosage requirements or with unusual sensitivity to relatively small doses of digitalis.

Topics: Animals; Antibodies; Antibodies, Anti-Idiotypic; Arrhythmias, Cardiac; Biological Availability; Cardiomyopathies; Cattle; Cooperative Behavior; Digitalis Glycosides; Digoxin; Drug Interactions; Drug Resistance; Humans; Infant; Intestinal Absorption; Malabsorption Syndromes; Radioimmunoassay; Tablets; Tachycardia; Tritium

Anthracyclines have cardiotoxic side effects. Cardioprotective drugs such as angiotensin-converting enzyme inhibitors and beta-blockers are therefore recommended for patients with anthracycline-induced cardiomyopathy. We herein present a 54-year-old woman with recurrent metastatic breast cancer who developed heart failure (HF) with a left ventricular ejection fraction (LVEF) of 22% after undergoing epirubicin chemotherapy. However, her HF symptoms and low LVEF persisted despite 5 months of cardioprotective therapy and additional oral pimobendan. Pimobendan was discontinued because of ventricular arrhythmia and hypotension. After the start of low-dose (0.125 mg daily) digoxin, her LVEF increased to 42%, and her HF symptoms improved with no adverse events.

Topics: Anthracyclines; Breast Neoplasms; Cardiomyopathies; Digoxin; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Stroke Volume; Ventricular Function, Left

Guanxin Shutong (GXST) capsule is a renowned traditional Chinese medicine widely used for the treatment of cardiovascular diseases in the clinic. However, no pharmacological experimental studies of GXST has been reported on the treatment of pressure overload-induced heart failure. This study aimed to investigate the effects of GXST capsule on ameliorating myocardial fibrosis conditions in pressure overload-induced heart failure rats.. Rats were randomly divided into 6 groups: Normal group, Model group, GXST-treated group at a dose of 0.5 g/kg, 1 g/kg, 2 g/kg, respectively, and digoxin positive control group at a dose of 1 mg/kg. After 4 weeks of administration, cardiac function was evaluated by echocardiography. Cardiac injury and fibrotic conditions were evaluated by H&E staining, Masson staining, and Sirius Red staining. Myocardial fibrosis was evaluated by immunohistochemistry staining and Western blot.. GXST significantly inhibited cardiac fibrosis, reduced the excessive deposition of collagen, and finally improved cardiac function. GXST reversed ventricular remodeling might be through the TGF-β/Smad3 pathway.. GXST capsule demonstrated a strong anti-fibrosis effect in heart failure rats by inhibiting the TGF-β/Smad3 signaling pathway.

Topics: Animals; Aorta, Thoracic; Capsules; Cardiomyopathies; Collagen; Constriction; Digoxin; Disease Models, Animal; Drugs, Chinese Herbal; Echocardiography; Fibrosis; Heart Failure; Ligation; Male; Medicine, Chinese Traditional; Myofibroblasts; Rats, Sprague-Dawley; Signal Transduction; Smad3 Protein; Transforming Growth Factor beta; Ventricular Remodeling

Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes.. To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]).. The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52 014 patients with AF were enrolled between March 2010 and August 2016. A total of 11 738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018.. One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed.. Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals.. The median age of the population was 71.0 years, 22 987 of 52 013 were women (44.2%) and 31 958 of 52 014 were white (61.4%). Of 11 738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9).. Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM.. ClinicalTrials.gov Identifier: NCT01090362.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Cardiotonic Agents; Cardiovascular Diseases; Cohort Studies; Digoxin; Female; Guideline Adherence; Heart Failure; Hemorrhage; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Mortality; Myocardial Ischemia; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Proportional Hazards Models; Registries; Sodium Potassium Chloride Symporter Inhibitors; Stroke; Stroke Volume

Topics: Ataxia; Cardiomyopathies; Cardiomyopathy, Dilated; Child; Digoxin; Humans; Syndrome

A 13-year-old girl presented with progressive dyspnoea and palpitation, diagnosed on echocardiography as primary right ventricular cardiomyopathy with atrial fibrillation. Her thyroid profile was positive for antithyroid microsomal antibody, and antithyroid peroxidase antibodies were suggestive of autoimmune hypothyroidism. She was managed with furosemide, digoxin, acenocoumarol and thyroxine following which she showed significant improvement. This is a rare case of isolated right ventricular cardiomyopathy and its association with autoimmune hypothyroidism presenting at the age of 13.

Topics: Acenocoumarol; Adolescent; Anti-Arrhythmia Agents; Anticoagulants; Cardiomyopathies; Digoxin; Diuretics; Dyspnea; Echocardiography; Female; Furosemide; Hashimoto Disease; Humans; Thyroiditis, Autoimmune; Thyroxine; Treatment Outcome

Previous studies of cardiomyopathy among children perinatally infected with HIV were conducted before the routine use of HAART. Nucleoside analogs [nucleoside reverse transcriptase inhibitors (NRTIs)], the backbone of HAART, have been associated with mitochondrial toxicity, which can lead to cardiomyopathy. We evaluated the association of HAART and specific NRTIs associated with mitochondrial toxicity, on development of cardiomyopathy among perinatally HIV-infected children.. Three thousand and thirty-five perinatally HIV-infected children enrolled in a US-based multicenter prospective cohort study were followed for cardiomyopathy, defined as a clinical diagnosis or initiation of digoxin, from 1993 to 2007.. Cox models were used to estimate the effects of HAART and NRTIs on cardiomyopathy, identify predictors of cardiomyopathy among HAART users, and estimate the association between development of cardiomyopathy and mortality.. Ninety-nine cases of cardiomyopathy were identified over follow-up (incidence rate: 5.6 cases per 1000 person-years) at a median age of 9.4 years. HAART was associated with a 50% lower incidence of cardiomyopathy compared with no HAART use (95% confidence interval: 20%, 70%). Zalcitabine (ddC) use, however, was associated with an 80% higher incidence of cardiomyopathy. Among HAART users, older age at HAART initiation, ddC use before HAART initiation, initiating a HAART regimen containing zidovudine (ZDV), and a nadir CD4 percentage less than 15% were independently associated with a higher rate of cardiomyopathy. Cardiomyopathy was associated with a six-fold higher mortality rate.. HAART has dramatically decreased the incidence of cardiomyopathy among perinatally HIV-infected children. However, they remain at increased risk for cardiomyopathy and ongoing ZDV exposure may increase this risk.

Topics: Adolescent; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Cardiomyopathies; Cardiotonic Agents; CD4 Lymphocyte Count; Child; Child, Preschool; Cohort Studies; Digoxin; Female; Follow-Up Studies; HIV Seropositivity; Humans; Infant; Infectious Disease Transmission, Vertical; Male; Pregnancy; Prenatal Exposure Delayed Effects; Proportional Hazards Models; Prospective Studies; Treatment Outcome; United States; Zalcitabine; Zidovudine

Paediatric cardiomyopathy and heart failure are distinct but frequently associated conditions, which have a high mortality. Traditional medical therapy has evolved to incorporate newer classes of heart failure drugs, although the evidence to support efficacy in children is limited. This perspective article discusses the rationale, benefits and limitations of the various classes of drug therapy used in paediatric heart failure due to cardiomyopathy or congenital heart disease. Controversies in management and challenges for future development are highlighted.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathies; Cardiotonic Agents; Child; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Hydrazones; Natriuretic Peptide, Brain; Pyridazines; Simendan

The primary cause of cardiac dysfunction in thalassemia is believed to be myocardial iron overload. Besides iron, other factors may play a role in the impairment of myocardial contractility, including prolonged heart tissue hypoxia, pericardial involvement, arrhythmias, endocrine complications and vitamin D deficiency. We present the case of a 7 year-old boy with ?-thalassaemia major and cardiac dysfunction, pericardial effusion and associated endocrinopathies. His serum thyrotropin (TSH) level was increased, and total and free thyroxine (FT4) were low. In addition, biochemical results and serum PTH level were compatible with a diagnosis of hypoparathyroidism. Other laboratory findings were not consistent with rheumatic heart disease, viral myocarditis or autoimmune disease. The child was treated with digoxin, diuretics, oral calcium, vitamin D, L-thyroxine (25 microg daily, which was later gradually increased) and subcutaneous iron chelation therapy (45 mg/kg, six days/week). The patient was discharged from our Unit after 7 days and within 3 months he had appreciable myocardial improvement and disappearance of the pericardial effusion.

Topics: beta-Thalassemia; Calcium; Cardiomyopathies; Cardiotonic Agents; Child; Digoxin; Diuretics; Humans; Hypoparathyroidism; Hypothyroidism; Iron Chelating Agents; Iron Overload; Male; Pericardial Effusion; Thyroxine

To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy.. Case report.. Medical intensive care unit of a tertiary care academic medical center.. A 35-yr-old woman 5 wks postpartum from an uneventful spontaneous vaginal delivery who was transferred to our institution with fulminant hepatic failure and worsening hepatic encephalopathy of unknown etiology for consideration of liver transplantation.. An echocardiogram was obtained as part of an evaluation for refractory shock and the patient was found to have severe global hypokinesis with an ejection fraction of approximately 15%. She was diagnosed with peripartum cardiomyopathy and treatment with digoxin and afterload reduction was initiated.. After initiation of appropriate treatment for dilated cardiomyopathy, the patient's hepatic failure resolved and she made a full recovery.. Congestive heart failure is one of the few treatable causes of fulminant hepatic failure. Congestive heart failure must always be included in the differential diagnosis of fulminant hepatic failure of unknown pathogenesis.

Topics: Adult; Antihypertensive Agents; Blood Coagulation Disorders; Captopril; Cardiomyopathies; Cardiotonic Agents; Critical Care; Diagnostic Errors; Digoxin; Female; Humans; Hypertension; Hypotension; Liver Failure, Acute; Pregnancy; Pregnancy Complications, Cardiovascular; Renal Dialysis; Treatment Outcome

Bidirectional tachycardia is an uncommon and unique arrhythmia. It typically occurs in patients with digitalis toxicity, but it can also be associated with other causes. There has been controversy regarding the origin and the mechanism of bidirectional tachycardia. Treatment of bidirectional tachycardia involves the correction of reversible factors and the use of some antiarrhythmic medication.

Topics: Aged; Cardiomyopathies; Cardiotonic Agents; Cardiovascular Surgical Procedures; Digoxin; Electrocardiography; Female; Humans; Male; Monitoring, Intraoperative; Tachycardia

The aim of this survey was to assess the evaluation, management, and future recommendations of patients with the diagnosis of peripartum cardiomyopathy and to evaluate the interest in the creation of a prospective database regarding this rare disorder.. A total of 116 surveys were sent to major teaching institutions in the United States (including Puerto Rico), Canada, Crete, and South Korea after a national conference held at the National Institutes of Health regarding peripartum cardiomyopathy. This was an open-ended survey containing 17 specific questions regarding this disorder and its management.. A total of 78 (67%) maternal-fetal specialists responded to the survey. Diuretics and digoxin were used as first-line treatment for this disorder. Only 6% used angiotensin-converting enzyme inhibitors during pregnancy. Fifty-eight percent of the perinatologists (58%) recommended either intrauterine contraceptive devices or foam and condoms, whereas oral contraceptives (progesterone-only pill or estrogen-progesterone mix) were recommended in 23% and 41%, respectively. Sixty-six percent (66%) of the respondents would recommend future pregnancy if ventricular function returned to normal.. Fundamental clinical and basic research is lacking regarding this rare but potentially devastating disorder. Major teaching institutions do not have significant numbers of patients with this disorder to provide concrete recommendations, and starting a database will be useful in the gathering of important epidemiologic information. A secondary aim of such a registry would be to establish a repository for tissue and blood samples to answer basic mechanistic questions about this disorder.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathies; Digoxin; Diuretics; Female; Health Surveys; Humans; National Institutes of Health (U.S.); Perinatology; Pregnancy; Pregnancy Complications, Cardiovascular; Registries; Risk Factors; Surveys and Questionnaires; United States

To report a case of clarithromycin-induced digoxin intoxication.. A 78-year-old white man with ischemic cardiomyopathy and chronic renal insufficiency was admitted 4 days after being prescribed clarithromycin for a suspected episode of bronchitis. He reported weakness, asthenia, and gastrointestinal symptoms; the digoxin serum concentration was measured at 3.89 ng/mL. The patient recovered uneventfully after digoxin and clarithromycin were discontinued.. Erythromycin frequently interacts with other drugs that are also metabolized by the CYP3A4 isoenzyme. However, erythromycin is hypothesized to interact with digoxin by inhibiting Eubacterium lentum, which is a normal inhabitant of the human gut and is responsible for intestinal metabolism of digoxin in 10% of patients. Since clarithromycin shares a comparable antibacterial spectrum with erythromycin, the possibility of a drug interaction with digoxin remains. Only four cases of clarithromycin interacting with digoxin have been reported to date. Clinically, this interaction may have been more obvious because of our patient's moderate renal dysfunction and serum digoxin concentrations in the upper therapeutic range prior to clarithromycin initiation. Other causes for digoxin intoxication could not be identified.. Clarithromycin may inhibit the growth of E. lentum, which can lead to an increase in digoxin bioavailability and blood concentrations in patients in whom this intestinal metabolic pathway is present. Patients at risk include those with renal dysfunction, with serum concentrations in the upper therapeutic range, or with measured digoxin concentrations that are much lower than predicted by pharmacokinetic calculations. For these patients, appropriate therapy includes the selection of an alternative, noninteracting antibiotic or, if this is not possible, a temporary reduction of digoxin dosage.

Topics: Aged; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Blood Pressure; Bronchitis; Cardiomyopathies; Clarithromycin; Digoxin; Drug Interactions; Heart Rate; Humans; Kidney Failure, Chronic; Male

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

In congestive heart failure (CHF), endogenous compounds with ouabainlike activity (OLA) may contribute to the maintenance of the circulatory homeostasis by peripheral as well as central effects. In the present study, we assessed changes in peripheral (plasma and left ventricle) and central (pituitary, hypothalamus, pons, and cortex) OLA in two animal models of CHF and determined whether brain OLA mediates sympathetic hyperactivity in CHF. Cardiomyopathic hamsters with their controls were studied at 9 months of age for tissue OLA. Rats were studied 4 weeks after acute coronary artery ligation for tissue OLA and sympathetic activity. In both models, left ventricular end-diastolic pressure was markedly increased. CHF was associated with significant increases in both plasma and tissue OLA in both models. In the brain, the most marked (twofold to threefold) increases occurred in the hypothalamus. In vitro, all OLA measured could be blocked by antibody Fab fragments (Digibind). Conscious rats with CHF showed elevated plasma catecholamines and enhanced responses of mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) to air stress and to intracerebroventricular (ICV) injection of the alpha 2-adrenergic receptor agonist guanabenz compared with sham-operated rats. ICV administration of the Fab fragments did not change resting RSNA or responses to air stress at 1 hour. However, 18 hours after injection of the Fab fragments, resting RSNA levels had significantly decreased compared with the control values, and plasma catecholamine levels had decreased to control values.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Brain; Brain Chemistry; Cardiomyopathies; Catecholamines; Cricetinae; Digoxin; Guanabenz; Heart Failure; Hemodynamics; Immunoglobulin Fab Fragments; In Vitro Techniques; Male; Myocardial Infarction; Myocardium; Ouabain; Rats; Rats, Wistar; Stress, Physiological; Sympathetic Nervous System

The present study compared the effects of amrinone, dobutamine, dibutyryl cAMP, digoxin, and isoproterenol on mechanical performance, the high energy phosphate metabolites, and the [Ca2+]i transients in normal and cardiomyopathic hamster hearts with severe heart failure. In normal hearts dobutamine, dibutyryl cAMP, and isoproterenol increased left ventricular developed pressure, while amrinone and digoxin did not. However, the amplitude of [Ca2+]i transients was augmented with all drugs. Diastolic [Ca2+]i level was increased with dobutamine and lowered with dibutyryl cAMP and isoproterenol. In cardiomyopathic hearts with severe heart failure, left ventricular developed pressure, the amplitude of [Ca2+]i transients, the phosphorylation potential, and [cAMP]i were significantly depressed and left ventricular end-diastolic pressure and diastolic [Ca2+]i were significantly elevated when compared with normal hearts. Amrinone, dibutyryl cAMP, and isoproterenol improved mechanical performance while increasing [cAMP]i and the amplitude of [Ca2+]i transients, and decreasing diastolic [Ca2+]i. On the other hand, with dobutamine and digoxin diastolic [Ca2+]i was further increased and mechanical performance deteriorated with digoxin. Thus, distinct differences exist in modulation of mechanical performance, high-energy phosphate metabolism, and [Ca2+]i transients by positive inotropic drugs between normal and cardiomyopathic hearts with severe heart failure.

Topics: Amrinone; Animals; Blood Pressure; Bucladesine; Calcium; Cardiomyopathies; Cardiotonic Agents; Cricetinae; Digoxin; Disease Models, Animal; Dobutamine; Energy Metabolism; Heart Failure; Isoproterenol; Magnetic Resonance Spectroscopy; Mesocricetus; Myocardial Contraction; Oxygen Consumption; Phosphates; Phosphorylation

Three cases of diabetic myocardiopathy having history of diabetes, angina and left ventricular dysfunction of various degrees and confirmed by coronary angiography and endomyocardial biopsy were reported. Electrocardiography showed significant ST-T changes simulating coronary insufficiency but without definite localization. As to the treatment, nitrate preparations, inotropic agents such as strophanthin K, digoxin etc. were used to relieve the symptoms; insulin was also administered to control the blood glucose level. Diltiazem, a calcium blocker, is also of help in alleviating the symptoms. It is shown in the present study and in the literatures as well that diabetic myocardiopathy is a disease showing intramural microvascular endothelial proliferation and swelling as well as subendothelial accumulation of acid glycogen deposition cells. The transportation of intracellular calcium ions and the cellular metabolism are thus affected, so there are extensive ischemia, focal necrosis and fibrosis in the myocardium with resulting cardiac dysfunction. The authors are, therefore, of the opinion that diabetic myocardiopathy is a specific and separate clinical entity.

Topics: Aged; Angina Pectoris; Cardiomyopathies; Diabetes Complications; Digoxin; Female; Humans; Male; Middle Aged; Strophanthins; Ventricular Function, Left

Topics: Adult; Algorithms; Captopril; Cardiomyopathies; Diagnosis, Differential; Digoxin; Drug Administration Schedule; Female; Furosemide; Humans; Metoprolol; Postpartum Period; Prognosis

We report a case of myocardial necrosis in a newborn after treatment of the mother with long-term subcutaneous terbutaline. No such serious side effects in the fetus have previously been reported. We speculate that this myocardial damage was due to beta-sympathomimetic therapy.

Topics: Captopril; Cardiomyopathies; Digoxin; Echocardiography; Electrocardiography; Female; Furosemide; Humans; Infant, Newborn; Injections, Subcutaneous; Male; Necrosis; Obstetric Labor, Premature; Pregnancy; Terbutaline

Coenzyme Q10 (10 mg/kg/day) or digoxin (2 micrograms/kg/day) was given orally to cardiomyopathic hamsters (BIO 14.6) for 8 weeks from 12 weeks of age. The left ventricular weight per gram of body weight (mg/g) was lower (p less than 0.01) in the coenzyme Q10 group (3.09 +/- 0.13) than in the digoxin (3.32 +/- 0.20) and control (3.44 +/- 0.14) groups. Left ventricular function was evaluated in isovolumically beating hearts. Left ventricular developed pressure (63 +/- 5 vs. 54 +/- 10 mmHg, p less than 0.05), -dP/dt (1385 +/- 100 vs. 1211 +/- 136 mmHg/sec, p less than 0.05), and -dP/dt (1068 +/- 126 vs. 896 +/- 141 mmHg/sec, p less than 0.05) were greater in the coenzyme Q10 than in the control group. The time constant of left ventricular relaxation was shorter in the coenzyme Q10 group than in the control group (25 +/- 3 vs. 28 +/- 3 msec, p less than 0.05). By contrast, in the digoxin group, the indices of left ventricular function did not differ from the control group. These results suggest that coenzyme Q10, but not digoxin, attenuated disease progression and preserved left ventricular function in cardiomyopathic hamsters.

Topics: Animals; Body Weight; Cardiac Volume; Cardiomyopathies; Cricetinae; Digoxin; In Vitro Techniques; Mesocricetus; Myocardial Contraction; Ubiquinone; Ventricular Function, Left

Hamsters fed a Mg-deficient diet (MD) develop a cardiomyopathy (CM) with foci of myocardial necrosis, calcification, and modest mononuclear and giant cell infiltration. We hypothesize that the lesions are secondary to Ca overload following an increase in myocardial Na due to inhibition of (Na.K)-ATPase and secondary Na-Ca exchange. Nifedipine and digoxin were selected as agents to test this hypothesis. Hamsters were given nifedipine, digoxin, or placebo as sustained release subcutaneous pellets the same day they were started on the MD diet. Animals were killed after 14 days, and MD lesions were quantified in H&E stained slides. Regression analysis showed that nifedipine produced a dose-dependent reduction in lesion abundance (p less than .005) and diameter (p less than .05), while digoxin produced a dose-dependent increase in lesion abundance (p less than .005) and diameter (p less than .005). These results support the hypothesis that MDCM is secondary to Ca overload coupled to inhibition of (Na.K)-ATPase of cardiac myocytes.

Topics: Animals; Calcium; Calcium Channels; Cardiomyopathies; Cricetinae; Digoxin; Dose-Response Relationship, Drug; Heart; Magnesium; Magnesium Deficiency; Male; Mesocricetus; Myocardium; Nifedipine; Sodium; Sodium-Potassium-Exchanging ATPase

To compare the hemodynamic mode of action of captopril in patients with Congestive Heart Failure (CHF) with high- or low-plasma renin activity, we studied the systemic and renal hemodynamic changes induced by this drug in patients with refractory CHF (Group I) or untreated CHF (Group II). Plasma Renin Activity (PRA) was 7.46 +/- 3.7 ng/ml/hr in Group I and 1.15 +/- 0.45 ng/ml/hr in Group II. After the administration of captopril, these values increased to 14.35 +/- 6.19 and to 1.99 +/- 0.76 ng/ml/hr respectively (p less than 0.05). We observed that patients of Group I responded with increases in cardiac index and stroke volume and diminutions in total peripheral resistance, but Group II did not show any significant change in these variables. In contrast to this difference in responses between the refractory and untreated patients, both groups showed similar decreases in pulmonary artery and wedge pressures. Both groups also showed similar increases in plasma volume and effective renal plasma flow, and decreases in renal vascular resistance. These results show that captopril has predominantly venodilator effects in patients with CHF with low PRA levels, and it acts as a mixed vasodilator in patients refractory to conventional therapy, receiving high doses of diuretics, and in whom PRA is elevated. Our results also suggest that the venodilator action of captopril is not mediated by the Renin-Angiotensin System.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cardiomyopathies; Digoxin; Drug Therapy, Combination; Female; Furosemide; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Circulation; Renal Circulation; Renin

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the middle-aged and elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation may dominate the clinical picture and mask the more classical endocrine manifestations of the disease. Pitfalls in diagnosis and the importance of early recognition and treatment are discussed. Despite experimental evidence for a short-term inotropic action of thyroid hormone excess, clinical data support the existence of a reversible cardiomyopathy in hyperthyroidism with impaired contractile reserve. Enhanced myocardial performance at rest primarily reflects the peripheral actions of thyroid hormone excess. Most, if not all, of the cardiac abnormalities return to normal once a euthyroid state has been achieved, although atrial fibrillation may persist in a minority. Optimum treatment requires rapid and definitive antithyroid therapy, usually using a large dose of radio-iodine, and rapid control of heart failure. Systemic anticoagulation is indicated in the presence of atrial fibrillation and should be continued until sinus rhythm has been present for at least three months, either spontaneously or after cardioversion.

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiomyopathies; Digoxin; Drug Therapy, Combination; Heart Diseases; Heart Rate; Hemodynamics; Humans; Hyperthyroidism; Myocardial Contraction; Myocardial Infarction; Sympathetic Nervous System; Thyroid Function Tests; Thyroid Hormones

The role of calcium was investigated in myocardial cell necrosis induced by cardiac glycoside. Experimental poisoning caused an increase of Ca45. Excessive intracellular calcium uptake must be the determining factor in the aetiology of myocardial cell damage. The possible involvement of calcium increase in the genesis of cardiac glycoside induced myocardial cell necrosis is discussed.

Topics: Adenosine Triphosphatases; Animals; Autoradiography; Biological Transport, Active; Calcium; Cardiomyopathies; Digoxin; Female; Male; Microscopy, Electron; Necrosis; Rabbits

Cardiac dysfunction is common in patients with terminal renal failure. However, no consensus has been reached with respect to the indications for digitalis therapy. Depression of myocardial contractility may occur as a result of circulating toxic factors, parathyroid hormone, and altered catecholaminergic responsiveness. On the other hand, paradoxical positive inotropic effects have been observed possibly as a result of a circulating natriuretic factor (an endogenous digitalis analogue) which inhibits Na,K-ATP'ase. Pharmacokinetics and pharmacodynamics of digitalis steroids are altered in uremia. Elimination half-lives of strophanthin and digoxin are prolonged, whereas the elimination half-life of digitoxin is unchanged. Altered protein binding and volume of distribution have been noted. Despite its long elimination half-life, most nephrologists favor administration of digitoxin because of its insensitivity to changes in renal function.

Topics: Animals; Biological Availability; Blood; Blood Proteins; Cardenolides; Cardiomyopathies; Cats; Digitalis; Digitoxin; Digoxin; Dogs; Dose-Response Relationship, Drug; Guinea Pigs; Humans; Kidney Failure, Chronic; Kinetics; Metabolic Clearance Rate; Myocardial Contraction; Peritoneal Dialysis, Continuous Ambulatory; Plants, Medicinal; Plants, Toxic; Rabbits; Rana temporaria; Rats; Renal Dialysis; Saponins; Sodium-Potassium-Exchanging ATPase; Stimulation, Chemical; Ultrafiltration; Uremia

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 treatment of congestive cardiomyopathy is dependent on clinical findings, reduced ejection fraction and presence of congestion. Diet, digitalis and vasodilator drugs: prazosin or dihydralazine are used in congestive cardiomyopathy class I or II (NYHA). In the presence of congestion diuretics are added, in chronic congestion of the lung nitrate. Congestive cardiomyopathy class III or IV (NYHA) is treated with diet, digitalis and the converting enzyme inhibitor captopril. In the therapy of HOCM or HNCM the calcium antagonist verapamil is now widely used and seems to be replacing the beta-blocker treatment with propranolol. If treatment with beta-blocker and calcium antagonists in patients with HOCM class III or IV (NYHA) ist ineffective surgical therapy is necessary.

Topics: Adrenergic beta-Agonists; Anti-Arrhythmia Agents; Anticoagulants; Captopril; Cardiac Glycosides; Cardiomyopathies; Diet, Sodium-Restricted; Digitoxin; Digoxin; Dihydralazine; Diuretics; Humans; Nitrates; Practolol; Prenalterol; Temperance; Vasodilator Agents; Verapamil

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

We attempted to alter the inherited myocardial damage and loss of contractility of the cardiomyopathic Syrian hamster (strain U-MX7-1) by giving cardiac drugs that altered intracellular calcium and myocardial workload. Thirty-seven 21-day-old cardiomyopathic and thirty-seven 21-day-old normal hamsters were divided into five groups each: verapamil-, propranolol-, digoxin-, hydralazine-, and saline-injected. On their 90th day of life, the hamsters were killed. Of the five cardiomyopathic groups, only verapamil reduced myocardial damage. When both "control" and cardiomyopathic hamsters were treated with saline, digoxin, or propranolol, the cardiomyopathic hamsters had significantly less contractile force, maximal rate of force development, and maximum velocity of unloaded shortening. When both groups were treated with verapamil or hydralazine, there were no significant group differences in the indices of contractility. However, when saline-treated cardiomyopathic hamsters were compared with drug-treated cardiomyopathic hamsters, only verapamil preserved myocardial contractility. There was also a weak correlation between the Vmax and the actin-activated ATPase activity of the cardiomyopathic hamsters (r = 0.63, P less than 0.001). We conclude that verapamil helped protect the myocardium of genetically cardiomyopathic hamsters against structural damage, and helped preserve myocardial contractility.

Topics: Actins; Adenosine Triphosphatases; Animals; Cardiomyopathies; Cricetinae; Digoxin; Hydralazine; Mesocricetus; Myocardial Contraction; Myocardium; Myosins; Papillary Muscles; Sodium Chloride; Verapamil

Topics: Administration, Oral; Blood Pressure; Cardiac Output; Cardiomyopathies; Cardiotonic Agents; Digoxin; Heart Failure; Heart Rate; Hemodynamics; Humans; Prazosin; Vascular Resistance; Vasodilator Agents; Venous Pressure

Digoxin (5 mg/ml) was added to 10-mg and 20-mg pellets of purified primary and secondary amyloid fibrils, a normal human liver and heart homogenate and a homogenate from the heart of a patient with amyloid cardiomyopathy who had not received digitalis. After centrifugation, the supernatants were recovered and assayed for digoxin concentrations. Aliquots from the sediments were studied for the presence of digoxin, using rabbits antidigoxin antiserum and an indirect immunofluorescent technique. The results showed that 0.11--0.13 ng/ml of digoxin bound per milligram of fibrils and could not be separated by repeated washings. Elution with citrate or changes in the pH of the buffer. Immunofluorescent studies demonstrated diffusely bright immunofluorescence with the fibril preparation and amyloid heart homogenate when reacted with digoxin and digoxin-specific antiserum. These studies demonstrate that isolated amyloid fibrils bind digoxin and suggest that this interaction may play some role in the sensitivity to digitalis that has been observed in some patients with amyloid cardiomyopathy.

Topics: Amyloid; Animals; Antibodies; Binding Sites; Cardiomyopathies; Digoxin; Fluorescent Antibody Technique; Heart; Humans; Immune Sera; Muscles; Rabbits

Topics: Age Factors; Aged; Arrhythmias, Cardiac; Cardiomyopathies; Creatinine; Digitalis Glycosides; Digoxin; Electrocardiography; Female; Humans; Kidney; Male; Middle Aged

In this case report, a congestive cardiomyopathy caused by long-term organic phosphoric acid ester exposure is described. The cardiotoxicity and the role of such poisons in the genesis of cardiomyopathy are also discussed.

Topics: Adult; Cardiomyopathies; Digoxin; Humans; Male; Occupational Diseases; Organophosphate Poisoning

Topics: Cardiomyopathies; Digoxin; Humans

Topics: Arrhythmias, Cardiac; Cardiomyopathies; Digoxin; Diuretics; Humans

Digoxin serum levels in 41 children with clinical and/or ECG symptoms of digitoxicity were determined by radioimmunoassay and compared to the normal values. 54% of the cases showed a good relationship between clinical and/or ECG signs of toxicity and digoxin levels; on the contrary, 29% of patients exhibited only clinical and/or ECG signs of toxicity with normal digoxin levels and 17% of patients had high digoxin levels without signs of toxicity. The significance and possible causes of this relative discrepancy are discussed.

Topics: Adult; Arrhythmias, Cardiac; Cardiomyopathies; Child; Child, Preschool; Digitalis Glycosides; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant; Radioimmunoassay

The EKG response to exercise and the working capacity in a group of 70 patients with positive serology for Chagas' disease has been determined by stress testing on a bicycle-ergometer, in order to establish the usefulness of such a test in the early diagnosis of Chagas' cardiomyopathy. The exercise EKG provides information which cannot be obtained by other diagnostic procedures, since the stress test can induce or increase ventricular arrhythmia, and is particularly indicated in patients with Chagas' infection and the incipient forms of Chagas' cardiomyopathy. Measuring the working capacity is useful in order to establish the degree of functional impairment of each individual patient. After the application of oral digoxin, no significant increase of ventricular extrasystoles following exercise has been observed and the working capacity has improved in the majority of the studied cases with Chagas' cardiomyopathy.

Topics: Administration, Oral; Adult; Aged; Arrhythmias, Cardiac; Cardiomyopathies; Chagas Disease; Digoxin; Exercise Test; Female; Humans; Male; Middle Aged

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: Arrhythmias, Cardiac; Cardiomyopathies; Chagas Disease; Digoxin; Exercise Test; Heart Rate; Humans

Topics: Adolescent; Adult; Cardiomyopathies; Chagas Disease; Digoxin; Drug Evaluation; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Postoperative Complications

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Topics: Cardiomyopathies; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction; Myocarditis

Five patients were seen at the Mayo Clinic over an 8-year period with the following complex of clinical and morphologic features; striking eosinophilia, cardiomyopathy, hepatosplenomegaly, and either a rapidly fatal or a prolonged, debilitating illness. In recent years, controversy has raged over the precise designation of this syndrome, with proposals ranging from eosinophilic leukemia to hypereosinophilic syndromes. To focus on the major target organ of the disease, we have favored the term endomyocardiopathy with eosinophilia. Experience with these five patients showed that (1) eosinophilia can persist for many years before symptoms appear; (2) progressive restrictive cardiac disease was the major cause of death and debility; (3) osmiophilic cytoplasmic inclusions are present in eosinophils of these patients and also in cells from other patients with marked eosinophilia; and (4) echocardiography may prove to be a useful noninvasive tool to diagnose and follow the progress of cardiac involvement. Although none of these patients was thought to have leukemia, intensive therapy with steroids or cytotoxic agents, or both, is considered necessary to control the progression of the disease.

Topics: Adolescent; Adult; Busulfan; Cardiomyopathies; Cytoplasmic Granules; Digoxin; Diphenhydramine; Eosinophilia; Eosinophils; Female; Furosemide; Hepatomegaly; Humans; Hydroxyurea; Male; Middle Aged; Prednisone; Splenomegaly; Syndrome

Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is such patients may require revision.

Topics: Adult; Blood Pressure; Cardiac Catheterization; Cardiac Output; Cardiomyopathies; Coronary Disease; Digoxin; Heart Failure; Hemodynamics; Humans; Injections, Intravenous; Middle Aged; Pulmonary Circulation; Time Factors; Vascular Resistance

Topics: Cardiomyopathies; Coronary Disease; Digoxin; Heart Valve Diseases; Humans

Topics: Alcohol Drinking; Anticoagulants; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diet, Sodium-Restricted; Digitalis; Digoxin; Diuretics; Ethanol; Female; Heart; Heart Failure; Humans; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Practolol; Pregnancy; Propranolol; Rest

Topics: 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: Animals; Aorta; Cardiomyopathies; Constriction; Digoxin; Heart; Hypertrophy; Myocardium; Organ Size; Rabbits; Time Factors; Tritium

Topics: Cardiomyopathies; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Follow-Up Studies; Humans; Infant; Male; Myocarditis; Procainamide; Prognosis; Propranolol; Quinidine; Recurrence; Tachycardia, Paroxysmal; Time Factors; Ventricular Fibrillation

Topics: Administration, Oral; Aged; Cardiomyopathies; Carotid Arteries; Digoxin; Electrocardiography; Female; Heart; Humans; Injections, Intravenous; Male; Phonocardiography; Preoperative Care; Pulse

Topics: Anemia; Anti-Bacterial Agents; Cardiomyopathies; Diet, Sodium-Restricted; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Myocarditis; Palliative Care; Respiratory Tract Infections; Rest; Tachycardia, Paroxysmal

Topics: Acetanilides; Adrenergic beta-Antagonists; Amino Alcohols; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Digoxin; Hemodynamics; Humans; Isoproterenol; Propranolol

Topics: Adult; Angiocardiography; Black People; Cardiomyopathies; Digoxin; Diuretics; Electrocardiography; Female; Heart Failure; Hemoglobinometry; Humans; Hypertension; Middle Aged; Nigeria; Parity; Phonocardiography; Pregnancy; Puerperal Disorders

Topics: Administration, Oral; Animals; Cardiac Catheterization; Cardiac Output; Cardiomyopathies; Chagas Disease; Coronary Disease; Digitalis Glycosides; Digoxin; Dogs; Electrocardiography; Heart Diseases; Hemodynamics; Humans; Hypertension; Male; Mitral Valve Insufficiency; Ouabain; Oxygen Consumption; Phonocardiography

Topics: Adult; Aged; Animals; Cardiomyopathies; Cardiovascular Diseases; Cats; Digoxin; Female; Heart Valve Diseases; Humans; Ischemia; Male; Middle Aged; Potassium Deficiency; Pulmonary Heart Disease

Topics: Aminophylline; Aspirin; Atropine; Cardiomyopathies; Cataract; Child, Preschool; Chloramphenicol; Chlorothiazide; Conjunctivitis; Digoxin; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Ophthalmic Solutions; Pre-Eclampsia; Pregnancy; Purpura, Thrombocytopenic; Substance-Related Disorders; Suppositories

Topics: Cardiomyopathies; Digoxin; Ethiopia; Heart Diseases; Heart Valve Diseases; Humans; Hydrochlorothiazide; Pulmonary Edema; Radiography

Topics: Cardiomyopathies; Child; Child, Preschool; Coronary Disease; Diagnosis, Differential; Digoxin; Humans; Hypertension; Infarction; Mitral Valve Insufficiency; Pericarditis, Constrictive; Prognosis

Topics: Cardiac Catheterization; Cardiomyopathies; Desoxycorticosterone; Diagnosis; Digoxin; Drug Therapy; Edema; Guanethidine; Heart Diseases; Heart Failure; Humans