digoxin and Cerebrovascular-Disorders

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a frequently prescribed group of highly effective drugs of which the most well-known side effect is gastrointestinal peptic ulcer. However, NSAIDs have additional renal, cardiovascular, hematological, dermatological, and neurological side effects. Although the spectrum of side effects is slightly different between the conventional NSAIDs and the recently developed cyclooxygenase 2 (COX-2) inhibitors, their overall spectrum is quite similar. Aim of this review is to summarize the current knowledge about NSAIDs and their effects on patients with cardio- or cerebrovascular disorders. NSAIDs interact with many drugs which are used in patients with cardio- or cerebrovascular disorders: They attenuate the effects of diuretics, betablockers, ACE inhibitors and AT-2 blockers, thus leading to uncontrolled hypertension or aggravation of heart failure. They increase digoxin levels, potentiate the effect of oral anticoagulants and interact with platelet inhibitors, thus leading to a higher bleeding risk. There are indications that NSAIDs may induce hypertension in normotensives and that COX-2 inhibitors may lead to an increased rate of myocardial infarction and strokes. Based on these data it is recommended that NSAIDs should be avoided in patients with cardio- or cerebrovascular disorders and alternative pharmaceutical, physical or surgical therapy should be applied. If NSAIDs are inevitable, their side effects should be well monitored; they should be prescribed with caution when given in combination with diuretics, betablockers, ACE inhibitors, AT-2 blockers, digitalis, oral anticoagulants and platelet inhibitors. COX- 2 inhibitors should be avoided in patients with known coronary or cerebrovascular disorders. In patients with uncontrolled hypertension or worsening of heart failure, unreported NSAID-use should be considered. Generally, there is a need to develop further analgetic drugs without the described side effects for patients with cardio- and cerebrovascular disorders.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Diseases; Cerebrovascular Disorders; Digoxin; Diuretics; Drug Interactions; Heart Failure; Humans; Hypertension; Myocardial Infarction; Pain

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Atrial Fibrillation; Cerebrovascular Disorders; Coronary Artery Bypass; Costs and Cost Analysis; Digoxin; Heart Rate; Humans; Postoperative Complications; Risk Factors; Sulfonamides

Because of its prevalence in the population and its associated underlying diseases and morbidity, atrial fibrillation (AF) is an important and costly health problem. Advancing age, diabetes, heart failure, valvular disease, hypertension, and myocardial infarction predict the occurrence of AF within a population. The management of AF is complex and involves prevention of thromboembolic complications and treatment of arrhythmia-related symptoms. Stroke occurs in 4.5% of untreated patients with AF per year. Independent risk factors for stroke in nonrheumatic patients with AF are advanced age; a history of prior embolism, hypertension, or diabetes; and echocardiographic findings of left atrial enlargement and left ventricular dysfunction. Warfarin decreases stroke by two-thirds and death by one-third; aspirin is only about half as effective overall and is insufficient therapy for those with risk factors for stroke. Options for thromboembolic prophylaxis are use of warfarin for all in whom it is safe or, alternatively, warfarin for those with risk factors and aspirin for those without risk factors. One-half of the patients with AF are 75 years of age or older. The uniform applicability and relative safety of warfarin therapy in this age-group are controversial. Specific therapy for the arrhythmia should be dictated by the need to control symptoms. Symptomatic treatments include rate-control medications and strategies designed to terminate and prevent arrhythmia recurrence. Digoxin, beta-adrenergic blockers, verapamil, and diltiazem slow excessive ventricular rates in patients with AF and may favorably manage comorbid conditions. The efficacy of anti-arrhythmic medications is only 40 to 70% per year in preventing recurrences of AF, and these agents, except amiodarone, may increase the risk of sudden death in patients with certain types of organic heart disease and AF. The use of nonpharmacologic symptomatic therapies such as atrioventricular node modification or ablation with a rate-response pacemaker or surgical intervention is increasing.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Aged; Anti-Arrhythmia Agents; Aspirin; Atrial Fibrillation; Catheter Ablation; Cerebrovascular Disorders; Diabetes Complications; Digoxin; Diltiazem; Embolism; Humans; Hypertension; Thromboembolism; Verapamil; Warfarin

Topics: Adrenergic beta-Antagonists; Amiodarone; Arrhythmias, Cardiac; Atrial Fibrillation; Catheter Ablation; Cerebrovascular Disorders; Defibrillators, Implantable; Digoxin; Electrophysiology; Heart; Heart Failure; Humans

The main goal of therapy in atrial fibrillation is to restore sinus rhythm, if this is possible, to avoid adverse hemodynamic, electrical, and embolic consequences. The restoration of sinus rhythm is urgent if the patient is unstable. In a stable patient, if the duration is shorter than 48 hours and an atrial thrombus is unlikely, then sinus rhythm can be restored after initial rate control. If the duration of atrial fibrillation is more than 48 hours, the embolic risk may be significant, and anticoagulation will be required for 2 to 4 weeks before an attempt at cardioversion. In patients in whom sinus rhythm cannot be restored or maintained, the goal of therapy is rate control and reduction of embolic risk unless the risk of anticoagulation outweighs its benefit. In difficult cases, rate control may be accomplished with AV nodal ablation and pacemaker implantation or with one of the surgical procedures described above with varying degrees of normalization of the physiology. Although not included in this flow chart, we do not advocate episodic intermittent therapy for patients with infrequent episodes of atrial fibrillation because this could be potentially dangerous and may place the patient at a higher risk for developing proarrhythmia.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Catheter Ablation; Cerebrovascular Disorders; Digoxin; Electric Countershock; Humans; Pacemaker, Artificial

Atrial fibrillation is associated with potentially life-threatening strokes. Anticoagulation with warfarin or aspirin reduces the risk of embolic events in patients with chronic atrial fibrillation and mitral valve stenosis or other underlying heart disease. In patients with acute onset of atrial fibrillation, anticoagulation is not necessary before cardioversion. However, in patients with chronic atrial fibrillation, anticoagulation should be started three weeks before cardioversion and continued for four weeks after the return of normal sinus rhythm. Quinidine remains the agent most commonly used for medical cardioversion in patients who are hemodynamically stable. If a patient is hemodynamically unstable or the atrial fibrillation is not corrected with drug therapy, direct-current electrical cardioversion has a high success rate. Antiarrhythmic (quinidine) therapy is often continued indefinitely to help maintain sinus rhythm.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Calcium Channel Blockers; Cerebrovascular Disorders; Diagnosis, Differential; Digoxin; Drug Monitoring; Electric Countershock; Electrocardiography; Family Practice; Humans

In a controlled double-blind trial in 80 patients with cerebrovascular and cardiac insufficiency the differentiated effect of a combination therapy with cardiac glycosides and Hydergin were studied both with regard to parameters of cerebral organic and cardiac performance. Two randomized collectives of patients with an average age of 63 years were compared with each other for this purpose. They received either acetyldigoxin (0.4 mg/day) alone or in combination with Hydergin (3 mg/day). Duration of treatment was 8 weeks altogether. The single treatment with the cardiac glycoside alone does not lead to a satisfactory improvement in the symptoms of cerebral attacks. The results presented of this study support the necessity in these patients of an internist basic therapy in combination with a preparation like Hydergin acting favorably on cerebral metabolism.

Topics: Acetyldigoxins; Cerebrovascular Disorders; Digoxin; Dihydroergotoxine; Double-Blind Method; Female; Heart Failure; Humans; Male; Middle Aged

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

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digoxin; Female; Heart Failure; Humans; Male; Middle Aged; Pyridines; Pyrithioxin

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digoxin; Drug Combinations; Female; Heart Failure; Humans; Male; Middle Aged; Nicotinic Acids

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digoxin; Dihydroergotoxine; Drug Combinations; Female; Humans; Male

We conducted this study to evaluate whether there is an association between preoperative drug therapy and in-hospital mortality in patients undergoing coronary artery graft surgery. We collected data on 1593 consecutive patients undergoing coronary artery surgery. The relative risk of in-hospital mortality was determined by logistic regression with in-hospital mortality as the dependent variable, and independent variables that included known risk factors and preoperative cardioactive or antithrombotic drug treatment, i.e., age; left ventricular function; left main coronary artery disease; urgent priority; gender; previous cardiac surgery; concurrent cardiovascular surgery; chronic lung disease; creatinine concentration; hemoglobin concentration; diabetes; hypertension; cerebrovascular disease; recent myocardial infarction; prior vascular surgery; number of arteries bypassed; and regular daily treatment with beta-blockers, aspirin within 5 days, calcium antagonists, angiotensin converting enzyme (ACE) inhibitors, digoxin, or warfarin. In-hospital mortality was 3.3%. The relative risk of in-hospital mortality (with 95% confidence intervals of the relative risk) associated with the following drug treatments was: nitrates 3.8 (1.5-9.6), beta-blockers 0.4 (0.2-0.8), aspirin within 5 days 1.0 (0.5-1.9), calcium antagonists 1.1 (0.6-2.1), ACE inhibitors 0.8 (0.4-1.5), digoxin 0.7 (0.2-1.8), and warfarin 0.3 (0.1-1.6). We conclude that in-hospital mortality is positively associated with preoperative nitrate therapy and negatively associated with beta-adrenergic blocker therapy. A significant association between in-hospital mortality and the preoperative use of calcium antagonists, ACE inhibitors, aspirin, digoxin, and warfarin was not confirmed.. We examined the association between common drug treatments for ischemic heart disease and short-term survival after cardiac surgery using a statistical method to adjust for patients' preoperative medical condition. Death after surgery was more likely after nitrate therapy and less likely after beta-blocker therapy.

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Aspirin; Cardiotonic Agents; Cerebrovascular Disorders; Chronic Disease; Coronary Artery Bypass; Coronary Disease; Creatinine; Diabetes Complications; Digoxin; Female; Fibrinolytic Agents; Forecasting; Hemoglobins; Hospital Mortality; Humans; Hypertension; Logistic Models; Lung Diseases; Male; Middle Aged; Myocardial Infarction; Nitrates; Reoperation; Risk Factors; Sex Factors; Survival Rate; Ventricular Function, Left; Warfarin

Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke.. This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account.. All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26+/-0.11) than men without atrial fibrillation (+0.14+/-0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24+/-0.12 in the 36 men with atrial fibrillation and +0.17+/-0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05+/-0.21) than those without treatment (n=9; -1.14+/-0.34; adjusted P=0.0005). Previous myocardial infarction was not associated with impaired cognitive results.. In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Cerebrovascular Disorders; Cognition; Cognition Disorders; Cohort Studies; Cross-Sectional Studies; Digoxin; Female; Humans; Male; Neuropsychological Tests; Risk Factors

Topics: Anaphylaxis; Anticoagulants; Brain Edema; Cerebrovascular Disorders; Dextrans; Digoxin; Hemodilution; Heparin; Humans; Intracranial Embolism and Thrombosis; Pulmonary Edema; Risk; Strophanthins

24 h after ligation of the left middle cerebral artery in cats (sham operation in the control group), a constant intravenous infusion of digoxin was begun and continued to toxicity (ventricular rhythm) and death. We found that the lethal dose of digoxin was significantly less in the stroke group than in the control group, but the lethal plasma digoxin concentration was significantly greater in the stroke group than in the control group. In a subsequent study, we demonstrated that ischemic stroke caused a significant prolongation in the elimination half-life of digoxin and an increase in the volume of distribution. The mean plasma clearance of the stroke group was approximately three fourths of that of the control group. We concluded that the decreased tolerance to digoxin after ischemic stroke was due to the prolonged half-life and decreased clearance of digoxin.

Topics: Animals; Blood Gas Analysis; Blood Pressure; Cats; Cerebrovascular Disorders; Digoxin; Electrocardiography; Hematocrit; Ischemic Attack, Transient; Kinetics

Topics: Aged; Cerebrovascular Disorders; Digoxin; Drug Combinations; Drug Evaluation; Female; Heart Diseases; Humans; Male; Middle Aged; Nicotinic Acids; Theobromine

Topics: Cerebrovascular Disorders; Digoxin; Disulfides; Drug Combinations; Feeding and Eating Disorders; Heart Diseases; Heart Failure; Humans; Pyridoxine

Topics: Aged; Aminosalicylic Acids; Arrhythmias, Cardiac; Arteriosclerosis; Cerebrovascular Disorders; Coronary Disease; Digoxin; Electrocardiography; Furosemide; Heart Conduction System; Humans; Hypertension; Isoniazid; Kidney Failure, Chronic; Lung Diseases, Obstructive; Middle Aged; Myocardial Infarction; Phenytoin

Topics: Adrenergic beta-Agonists; Aged; Atrial Fibrillation; Bradycardia; Cerebrovascular Disorders; Digitalis Glycosides; Digoxin; Heart Block; Heart Failure; Humans

Topics: Bile Acids and Salts; Cerebrovascular Disorders; Digoxin; Drug Synergism; Humans; Ischemia; Magnesium; Nicotinic Acids

Topics: Amines; Benzoates; Blood Pressure; Cardiac Glycosides; Cerebrovascular Circulation; Cerebrovascular Disorders; Diet Therapy; Digoxin; Humans; Hypertension; Theophylline

Topics: Aged; Benzamides; Benzoates; Central Nervous System Stimulants; Cerebrovascular Disorders; Digoxin; Female; Heart Failure; Humans; Male; Middle Aged; Theophylline; Vasodilator Agents

Topics: Cardiac Glycosides; Cerebrovascular Disorders; Digoxin; Humans