digoxin and Dyspnea

Pulmonary veno-occlusive disease (PVOD) is a rare and usually survival poor disorder. We report a patient with a long history of progressive dyspnea of over 8 years, who with a diagnosis of chronic cor pulmonale confirmed elsewhere, was ultimately diagnosed as PVOD via histological analysis of a lung biopsy. After treatment with combined bosentan, diuretics and digoxin, his symptoms and function improved. This case highlights that PVOD is an under-recognised and often misdiagnosed disease, especially in its chronic form. Understanding its pathogenesis, its poor response to medical therapy and its dismal prognosis remain challenges for the treatment of PVOD.

Topics: Adult; Antihypertensive Agents; Biopsy; Bosentan; Cardiotonic Agents; Diagnosis, Differential; Digoxin; Diuretics; Drug Therapy, Combination; Dyspnea; Humans; Hypertension, Pulmonary; Male; Pulmonary Heart Disease; Pulmonary Veno-Occlusive Disease; Sulfonamides; Time Factors; Tomography, X-Ray Computed

Topics: Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Digoxin; Diuretics; Dyspnea; Echocardiography; Edema; Exercise Tolerance; Female; Heart Failure; Humans; Male; Mineralocorticoid Receptor Antagonists; Natriuretic Peptide, Brain; Patient Education as Topic; Referral and Consultation; Terminal Care; Ventricular Dysfunction, Left

Topics: Acid-Base Equilibrium; Acidosis; Angiocardiography; Blood Gas Analysis; Blood Pressure; Bradycardia; Cardiac Catheterization; Cardiac Output; Child; Child, Preschool; Cineangiography; Cyanosis; Digoxin; Diuretics; Dyspnea; Electrocardiography; Heart Auscultation; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Oxygen Inhalation Therapy; Pulse; Referral and Consultation; Tachycardia; Vectorcardiography

This study has compared the effect on heart rate control of the addition of pindolol 15 mg bd or verapamil 40 mg tds to maintenance digoxin therapy in 12 patients with chronic atrial fibrillation. The study was performed in a randomized cross-over fashion. Treatment effects were assessed by 24-h ambulatory electrocardiography and symptomatic improvement by symptom scores. The results show that the combination of pindolol and digoxin provides better control of atrial fibrillation. With an attenuation of daytime tachycardia, prevention of nocturnal bradycardia and reduction in the length of nocturnal pauses in rhythm. Overall heart rate variability was significantly less with digoxin and pindolol (523 beats min-1 h-1) than with digoxin and verapamil (745 beats min-1 h-1). We conclude that, in the dosages employed, combined digoxin and pindolol therapy is superior to either digoxin and verapamil in combination or digoxin alone for the treatment of atrial fibrillation.

Topics: Adult; Aged; Atrial Fibrillation; Digoxin; Drug Therapy, Combination; Dyspnea; Female; Heart Rate; Humans; Middle Aged; Pindolol; Verapamil

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Creatinine; Digitalis; Digoxin; Dyspnea; Edema; Female; Heart Failure; Humans; Male; Middle Aged; New York; Phytotherapy; Placebos; Plants, Medicinal; Plants, Toxic; Respiratory Insufficiency; Skilled Nursing Facilities; Time Factors

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

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

Topics: Abdominal Pain; Anticoagulants; Anxiety; Cardiotonic Agents; Continuous Positive Airway Pressure; Digoxin; Dopamine; Dyspnea; Electrocardiography; Emergencies; Heart Septal Defects, Atrial; Heart Valve Prosthesis Implantation; Humans; Male; Metoprolol; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Treatment Outcome; Warfarin

Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. It is usually self-limiting or relatively easily treated with most cases responding to physical or pharmacological therapies. We describe a case of a woman in the third trimester of pregnancy who developed treatment-resistant supraventricular tachycardia and required induction of labour and delivery to stop the arrhythmia. A multidisciplinary team approach with a critical care trained nurse and a midwife, continuous arterial blood pressure monitoring, transthoracic echocardiography, and neuraxial analgesia facilitated safe birth in the delivery suite and termination of the arrhythmia.

Topics: Adult; Amides; Amnion; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Anti-Arrhythmia Agents; Delivery, Obstetric; Digoxin; Dyspnea; Echocardiography; Fatigue; Female; Fentanyl; Flecainide; Humans; Labor, Obstetric; Metoprolol; Oximetry; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Ropivacaine; Tachycardia, Supraventricular

We describe the case of an 83-year-old man with a family history of pulmonary hypertension (PH) who presented with severe pulmonary arterial hypertension (PAH) and later tested positive for a novel bone morphogenetic protein receptor 2 (BMPR2) gene mutation. To our knowledge, this may be the oldest reported patient with PAH in whom a BMPR2 mutation was initially identified.

Topics: Aged, 80 and over; Amlodipine; Bone Morphogenetic Protein Receptors, Type II; Bosentan; Digoxin; Dyspnea; Humans; Hypertension, Pulmonary; Male; Pulmonary Artery; Sulfonamides; Warfarin

An American Cocker Spaniel with low plasma taurine concentration (< 2 nmol/mL) was presented with dyspnoea associated with pulmonary oedema and a left ventricular shortening fraction of 9%. Emergency therapy with furosemide, dobutamine, nitroglycerine and oxygen supplementation led to a good response. Chronic therapy was started with enalapril, furosemide, digoxin and taurine. Improvement in all echocardiographic indices were noted over a 22 week follow-up, most notably an increase in left ventricular shortening fraction to 20%, a decrease of E-point septal separation from 14 mm to 7 mm and marked left ventricular remodelling. This degree of improvement in myocardial function may represent a direct link between dilated cardiomyopathy in the American Cocker Spaniel and plasma taurine deficiency. Alternatively, this response may reflect a breed-related cardiomyopathy with a natural history and therapeutic response not commonly seen in the more common large breed cardiomyopathy presentations.

Topics: Animals; Antihypertensive Agents; Breeding; Cardiomyopathy, Dilated; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Dog Diseases; Dogs; Dyspnea; Echocardiography; Enalapril; Female; Furosemide; Heart; Heart Ventricles; Nitroglycerin; Pulmonary Edema; Taurine; Vasodilator Agents

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Digoxin; Dyspnea; Emergencies; Female; Heart Block; Heart Failure; Humans; Immunoglobulin Fab Fragments; Nausea

Heart failure is a major health problem, particularly among the elderly who experience the long term consequence of coronary artery disease. Over the past several years, the heart failure program at Michael Reese Hospital has seen a large number of elderly patients with heart failure. Two-thirds of these patients had a previous myocardial infarction, while 20% had an idiopathic (dilated) cardiomyopathy. Herein, we review that experience, focusing particularly on clinical presentation, our non-invasive approach to objectively determining their functional capacity and the severity of their failure, and, finally, a consideration of the various aspects of their medical management.

Topics: Aged; Digoxin; Diuretics; Dyspnea; Heart Failure; Heart Function Tests; Humans; Hypokalemia; Vasodilator Agents

Topics: Diazepam; Digoxin; Diuretics; Dyspnea; Emergencies; Epinephrine; Glucocorticoids; Humans; Lidocaine; Myocardial Infarction; Nitrates; Pulmonary Edema; Theophylline

Topics: Abdomen, Acute; Aerosols; Child, Preschool; Chloral Hydrate; Cold Temperature; Coma; Croup; Diazepam; Digoxin; Dyspnea; Emergencies; Epiglottis; Epinephrine; Humans; Infant; Infant, Newborn; Laryngismus; Myocarditis; Plasma Substitutes; Posture; Prednisolone; Prednisone; Shock, Septic

Topics: Cardiac Glycosides; Catecholamines; Digoxin; Diuretics; Dose-Response Relationship, Drug; Dyspnea; Heart Failure; Humans; Pulmonary Edema; Vasodilator Agents

In 20 children needing treatment for symptomatic sick sinus syndrome, the average age at presentation was 7.1 years and ranged from 9 months to 18 years. Symptoms were never precise but, in retrospect, 5 children had syncope, 7 had a rapid heart action, 6 had dyspnoea or tachypnoea, 2 had nonspecific chest pains, 2 had pale spells, and 1 had a sudden hemiplegia. Symptoms followed cardiac surgery in 15 cases and were related to unoperated congenital heart disease in 2 and to myocarditis in 2. The aetiology was unknown in 1 case. The type of cardiac surgery resulting in the development of the sick sinus syndrome was predominantly related to atrial suturing. Both tachy- and bradydysrhythmias were found, including wandering atrial pacemaker (9 cases), junctional rhythm (19 cases), supraventricular tachycardia (9 cases), atrial flutter (11 cases), and atrial fibrillation (2 cases). Both atrial (8 cases) and ventricular (7 cases) premature beats were seen. All patients were given trials of drug therapy but difficulties were encountered. Cardioversion was used for tachyarrhythmias in 11 cases without serious problems. Six children had permanent cardiac pacemakers inserted with good results. Recognition of the sick sinus syndrome in childhood is important and treatment must be regulated by the severity of symptoms.

Topics: Adolescent; Arrhythmia, Sinus; Arrhythmias, Cardiac; Bradycardia; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Dyspnea; Female; Heart Block; Heart Defects, Congenital; Heart Rate; Hemiplegia; Humans; Infant; Male; Myocarditis; Pacemaker, Artificial; Pallor; Syncope

Topics: Adult; Antihypertensive Agents; Cardiac Catheterization; Contraceptives, Oral; Digoxin; Dyspnea; Electrocardiography; Ethinyl Estradiol; Female; Heart Failure; Humans; Hypertension; Inulin; Kidney Function Tests; Liver; Lynestrenol; Nephrosclerosis; Renin; Reserpine; Thirst

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: Adult; Digoxin; Dyspnea; Electrocardiography; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Female; Humans; Hypotension; Lincomycin; Male; Nausea; Sepsis; Staphylococcal Infections; Vomiting

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atropine; Bradycardia; Cardiac Complexes, Premature; Digoxin; Drug Hypersensitivity; Dyspnea; Heart Rate; Humans; Male; Middle Aged; Propranolol; Tachycardia; Uremia

Topics: Angiography; Chest Pain; Digoxin; Drug Therapy; Dyspnea; Humans; Pain; Pathology; Prednisone; Pulmonary Embolism; Pulmonary Heart Disease; Radiography, Thoracic