digoxin and Heart-Valve-Diseases

Pharmacological support for the appropriate use of drugs is important. To promote such support, it is necessary to be involved in drug therapy from viewpoints different from those of physicians and nurses, using tools unique to pharmacists, pharmacologically discuss individual cases, and investigate the validity of prescriptions by accumulating data. In Chapter 1, digoxin is necessary to monitor therapy very closely. In addition, patients with an impaired renal dysfunction have a predisposition for developing digitalis toxicity. In clinical cases, digoxin and verapamil are often co-administered for heart rate control, and we have observed the serum trough level of beta-methyldigoxin to be elevated due to drug-interaction. We build upon our previous findings and generated a simple index for the adequate administration dosage of beta-methyldigoxin based on variable degrees of renal function and the serum trough level of beta-methyldigoxin. In Chapter 2, to investigate risk factors of postoperative infection following cardiac surgery, we conducted a retrospective analysis of two surgical procedures, off-pump coronary artery bypass grafting (OPCAB) and surgery for valvular heart disease (valve operation). After discussing the analysis results with the respective physicians, the dosing guidelines for cefazolin (CEZ) were changed. We also analyzed the rate of CEZ replacement with other antibiotics after surgery finding that it decreased in both groups for OPCAB and valve operations. From these results, we conclude that, if CEZ is also administered intra-operatively when surgery is prolonged, its administration for two days following surgery is adequate for prophylaxis against postoperative infection.

Topics: Aged; Anti-Bacterial Agents; Cardiology Service, Hospital; Cefazolin; Coronary Artery Bypass, Off-Pump; Digoxin; Drug Information Services; Drug Interactions; Drug Therapy, Combination; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Pharmacy Service, Hospital; Risk Factors; Surgical Wound Infection; Verapamil

Topics: Age Factors; Arrhythmias, Cardiac; Calcium; Child; Coronary Care Units; Digitalis Glycosides; Digoxin; Electric Countershock; Electrocardiography; Endocrine System Diseases; Heart Diseases; Heart Failure; Heart Rate; Heart Valve Diseases; Humans; Kidney Failure, Chronic; Liver Diseases; Lung Diseases; Magnesium; Obesity; Ouabain; Poisoning; Potassium; Psychophysiologic Disorders; Pulmonary Heart Disease; Thyroid Diseases; Time Factors

A multicenter, placebo-controlled, randomized, double-blind trial compared the preventive effect of aprindine and digoxin on the recurrence of atrial fibrillation (AF) with placebo, and also compare the effectiveness of these 2 drugs in the prevention of AF. Patients with symptomatic paroxysmal or persistent AF who had converted to sinus rhythm (SR) were randomly assigned aprindine (40 mg/day), digoxin (0.25 mg/day) or placebo and followed up on an outpatient basis every 2 weeks for 6 months. Of the 141 patients from 36 participating centers, 47 were given aprindine, 47 digoxin, and 47 were on placebo. After the 6-month follow-up, the Kaplan-Meier estimates of the percentage of patients remaining free of recurrent symptomatic AF on aprindine, digoxin and placebo were 33.3%, 29.2% and 21.5%, respectively. In patients remaining in SR for 15 days after from the start of follow-up, freedom from recurrence was significantly more prevalent in the aprindine group than in the placebo group (p=0.0414), but there was no significant difference between the digoxin and placebo groups. The rate of adverse events was similar in the 3 groups. In conclusion, neither aprindine nor digoxin had a significant effect on preventing relapse of symptomatic AF; however, recurrence of AF occurred later with aprindine than with placebo or digoxin.

Topics: Aged; Anti-Arrhythmia Agents; Aprindine; Atrial Fibrillation; Coronary Disease; Diabetic Angiopathies; Digoxin; Double-Blind Method; Electric Countershock; Female; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Placebos; Safety; Time Factors

In 50 patients with chronic congestive heart failure (CCHF, III or IV class), aged 62.8 +/- 9.1 years, who were treated with digoxin (Dx) and furosemide (F) (investigation A), continuous 24-hour ecg registration was performed according to Holter. Next, this treatment was extended by two-week administration of nifedipine (N) or isosorbide dinitrate (S) (investigation B), followed by one-month addition of captopril (Cp) (investigation C). During the last two weeks Dx, F, N or Dx, F, S were administered with Cp being withdrawn (investigation D). At the end of each stage of the treatment ecg registration was repeated according to Holter. At the same time, during the investigation A there were performed determinations of blood serum sodium, potassium and digoxin concentrations, two-dimensional echocardiography and evaluation of submaximal exercise tolerance. In 96 per cent of patients with CCHF, treated with Dx and F, cardiac rhythm disturbances were found. In 53.3 per cent life-threatening ventricular arrhythmias occurred, including unstable ventricular tachycardia in 11.1 per cent of patients. Addition of N or S to the classical treatment did not decrease either patient number or amounts of cardiac rhythm disturbances in individual classes according to Lown. Also Cp did not affect numbers of patients with cardiac rhythm disturbances, but it decreased numbers of patients with life-threatening ventricular arrhythmias from 53.3 per cent to 28.9 per cent (from 24/45 to 13/45). At the same time, Cp significantly decreased numbers of ventricular arrhythmias in class 3 and 4a (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atrial Fibrillation; Captopril; Cardiac Output; Coronary Disease; Digoxin; Drug Therapy, Combination; Electrocardiography; Exercise Test; Female; Furosemide; Heart Block; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Isosorbide; Male; Middle Aged; Nifedipine; Tachycardia; Vasodilator Agents

Topics: Aged; Bradycardia; Clinical Trials as Topic; Digoxin; Female; Heart Diseases; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Pulmonary Edema; Pulmonary Heart Disease; Sclerosis

Topics: Clinical Trials as Topic; Coronary Disease; Digitoxin; Digoxin; Electrocardiography; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Strophanthins

The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).. The Chinese AF registry enrolled 2016 AF patients from 20 representative EDs, and the period of study was one year. Predictors of digoxin use and its relation to mortality were assessed by logistic and Cox regression analyses.. Digoxin was assigned in 609 patients (30.6%), and younger age, lower body mass index values, and existence of permanent AF, heart failure (HF), chronic obstructive pulmonary disease, and valvular heart disease were identified to be factors associated with digoxin use. During the follow-up, compared to patients without digoxin therapy, digoxin-treated patients had significantly higher risk of all-cause death (17.2% vs. 13.0%, P=0.012) and cardiovascular death (15.1% vs. 6.7%, P<0.001), but similar risk of sudden cardiac death (1.1% vs. 0.7%, P=0.341). However, after adjustment for related covariates, digoxin use was no longer notably associated with increased all-cause mortality (hazards ratio [HR] 0.973, 95% confidence interval [CI] 0.718-1.318) and cardiovascular death (HR 1.313, 95% CI 0.905-1.906). Besides, neutral associations of digoxin treatment to mortality were obtained in relevant subgroups, with no interactions observed between digoxin and gender, HF, valvular heart disease, or concomitant warfarin treatment in mortality risk.. In ED patients with AF, digoxin was more frequently assigned to vulnerable patients with concomitant HF or valvular heart disease, and digoxin use was not related to a significantly increased risk of mortality.

Topics: Age Factors; Aged; Aged, 80 and over; Allopurinol; Anti-Arrhythmia Agents; Atrial Fibrillation; Body Mass Index; Cardiovascular Diseases; Cause of Death; China; Comorbidity; Death, Sudden, Cardiac; Digoxin; Emergency Service, Hospital; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Mortality; Proportional Hazards Models; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Registries; Risk Factors

Congestive heart failure was diagnosed in a 27-year-old Indian ringneck parakeet with exercise-induced dyspnea. A grade IV/VI holosystolic murmur that radiated to the right sternal area was auscultated over the left side of the sternum. Radiography revealed progressive cardiomegaly, hepatomegaly, pulmonary edema, and accumulation of fluid within the coelomic cavity. Echocardiography revealed biatrial enlargement and enlargement of the right ventricle. Doppler recording revealed high velocity left and right atrioventricular valve regurgitation. Treatment with digoxin and furosemide alleviated clinical signs for approximately 10 months. Gross postmortem examination revealed cardiac enlargement and eccentric hypertrophy of both ventricles on cross-section. Pulmonary congestion and edema, hepatomegaly, hepatic congestion, and ascites were also evident. Histologic examination of the heart revealed myxomatous degeneration of the left atrioventricular valve, muscular hypertrophy of the right atrioventricular valve, and biventricular chronic myofiber degeneration and necrosis.

Topics: Animals; Bird Diseases; Digoxin; Diuretics; Echocardiography, Doppler, Color; Electrocardiography; Fatal Outcome; Furosemide; Heart Auscultation; Heart Failure; Heart Valve Diseases; Parakeets; Radiography, Thoracic; Ventricular Dysfunction

The management of arrhythmias during pregnancy is, in principle, similar to that in nonpregnant patients, however, special consideration must be given, to avoid adverse fetal effects. In pregnant women without organic heart disease, no drug therapy is usually needed for the management of supraventricular or ventricular premature beats, but potential stimulants, such as smoking, caffeine, and alcohol should be eliminated. In patients with mitral valve prolapse beta blocker may be preferred drug. In pregnant patients with organic heart disease, paroxysmal atrial or ventricular tachycardia may induce hemodynamic changes with consequences to the fetus. In paroxysmal atrial tachycardia vagal stimulation maneuvers should tried and, if this is not effective, adenosine or beta-adrenergic blocking agents should be used. Alternatively, verapamil may be given. In pregnant with atrial fibrillation, the goal of treatment is conversion to sinus rhythm or control of the ventricular rate by digoxin. Synchronized electrical cardioversion may become necessary when signs of cardiac decompensation or hypotension were developed. Ventricular arrhythmias may occur in the pregnant women with cardiomyopathy, valvular heart disease, mitral valve prolapse and congenital Q-T prolongation. Termination of ventricular arrhythmias can usually be achieved by intravenous lignocaine or procainamide or by electrical cardioversion. To prevent recurrences, quinidine can be used if the arrhythmia was not induced by QT prolongation or procainamide.

Topics: Adrenergic beta-Antagonists; Alcohol Drinking; Arrhythmias, Cardiac; Digoxin; Electric Countershock; Female; Heart Valve Diseases; Humans; Lidocaine; Mitral Valve Prolapse; Pregnancy; Pregnancy Complications, Cardiovascular; Procainamide; Quinidine; Secondary Prevention; Smoking; Smoking Prevention; Verapamil

Topics: Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digoxin; Female; Heart Valve Diseases; Humans; Middle Aged; Monitoring, Physiologic; Postoperative Period

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Valve Diseases; Humans; Male; Medigoxin; Middle Aged; Mitral Valve; Myocardial Infarction; Tachycardia; Time Factors

Topics: Ambulatory Care; Blood Circulation; Digoxin; Drug Administration Schedule; Heart Valve Diseases; Humans; Myocardial Contraction; Time Factors

Topics: Adult; Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digoxin; Female; Heart Valve Diseases; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Complications

On the patients with moderate and severe heart insufficiency haemodynamic, clinical and electrocardiographic examinations were carried out. After the application of digitoxin at the beginning in the majority of cases no favourable effects on clinical and haemodynamic findings could be proved. In 2 patients with cor pulmonale even a drastic deterioration with increase of the pulmonary pressure and formation of a pulmonary oedema developed. The temporary analysis of the systole and the estimation of the glycoside level did not give any reliable references. The recompensation began only after 2-3 days. In 5 out of 10 patients in whom the cardiac rhythm was continuously controlled by means of a tape storage device, after the application of digoxin ventricular extrasystoles appeared. Also in these cases increased as well as subtherapeutic digoxin-plasma levels were present. In 2 patients with hypertrophic obstructive cardiomyopathy the infundibular gradients were considerably increased by strophantin. The causes of the different reaction patters are to be sought in disease-specific peculiarities, in the degree of severity of the heart insufficiency, in the speed of the flooding of glycoside and several extracardiac factors.

Topics: Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Blood Pressure; Cardiac Complexes, Premature; Cardiomyopathy, Hypertrophic; Digitalis Glycosides; Digoxin; Female; Heart; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Edema; Pulmonary Heart Disease

Topics: Adult; Arrhythmias, Cardiac; Digoxin; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Postoperative Complications

Topics: Digoxin; Heart Valve Diseases; Humans; Myocardial Contraction; Rheumatic Heart Disease; Strophanthins

Topics: Adult; Aged; Animals; Blood Pressure; Digitoxin; Digoxin; Dogs; Echocardiography; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Muscle Proteins; Myocardium; Rabbits

The bioavailability of digoxin and lanatoside C from tablets and dragees and from solutions of the two substances has been investigated intraindividually in patients on maintenance therapy. Plasma levels and urinary excretion were analyzed by radioimmunoassay. Both plasma concentrations and urinary excretion were significantly higher after digoxin tablets (1.5+/-0.17 ng/ml; 0.15 mg/24 h) than after lanatoside C dragees (0.98+/-0.15 ng/ml; 0.1 mg/24 h). When equimolar solutions of both drugs, corresponding to 0.5 mg digoxin, were given, plasma concentrations and urinary excretion after digoxin (1.6+/-0.08 ng/ml; 0.14 mg/24 h) were again significantly higher than after lanatoside C (1.18+/-0.09 ng/ml; 0.1 mg/24 h). These results suggest that while the absorption of lanatoside C is lower than that of digoxin, it is better than has been generally assummed. The variability in the absorption of lanatoside C between patients is no greater than with digoxin.

Topics: Adolescent; Adult; Biological Availability; Biopharmaceutics; Digoxin; Dosage Forms; Female; Heart Failure; Heart Valve Diseases; Humans; Intestinal Absorption; Lanatosides; Male; Middle Aged; Solutions; Tablets

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

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics, and patients with valvular heart disease receiving digoxin and either conventional diuretics or triamterene or both. The group being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium efflux rate constants, and a rise in cellular sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant.

Topics: Digoxin; Diuretics; Heart Defects, Congenital; Heart Valve Diseases; Humans; Leukocytes; Potassium; Sodium; Triamterene

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

Topics: Adolescent; Adult; Digoxin; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Postoperative Complications; Time Factors

Topics: Adult; Child, Preschool; Digoxin; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Myocardium

Topics: Administration, Oral; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Heart Valve Diseases; Hemodynamics; Humans; Injections, Intramuscular; Injections, Intravenous; Myocardial Infarction; Pulmonary Edema; Vagus Nerve

Topics: Animals; Arteriosclerosis; Biopsy; Coronary Disease; Digoxin; Female; Heart Atria; Heart Valve Diseases; Humans; Myocardium; Oxidation-Reduction; Radioimmunoassay; Rats; Tritium

Topics: Adult; Digoxin; Electrocardiography; Heart Block; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Male; Radiography; Rheumatic Fever; Tachycardia, Paroxysmal; Time Factors

Topics: Aged; Arrhythmias, Cardiac; Digitalis Glycosides; Digitoxin; Digoxin; Heart Block; Heart Failure; Heart Valve Diseases; Humans; Middle Aged; Myocardial Infarction; Potassium Deficiency; Strophanthins

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Diuretics; Electroconvulsive Therapy; Endocarditis, Bacterial; Heart Aneurysm; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Lidocaine; Myocardial Infarction; Pacemaker, Artificial; Pericarditis, Constrictive; Potassium Deficiency; Rupture; Spironolactone; Tachycardia; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Topics: Age Factors; Aged; Aortic Diseases; Arrhythmias, Cardiac; Cardanolides; Coronary Disease; Digoxin; Female; Gastrointestinal Diseases; Heart Block; Heart Failure; Heart Valve Diseases; Humans; Lung Diseases; Male; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Tachycardia

Topics: Aged; Blood Urea Nitrogen; Calcium; Coronary Disease; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Evaluation Studies as Topic; Heart Failure; Heart Valve Diseases; Humans; Kidney Failure, Chronic; Middle Aged; Myocardial Infarction; Photometry; Potassium; Radioimmunoassay; Saliva; Specimen Handling; Spectrophotometry, Atomic

Topics: Animals; Cardiac Catheterization; Digoxin; Dogs; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heroin; Humans; Injections, Intravenous; Male; Postoperative Complications; Pseudomonas Infections; Self Medication; Staphylococcal Infections; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Administration, Oral; Adult; Aged; Analysis of Variance; Cardiovascular Physiological Phenomena; Digoxin; Electrocardiography; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heart Ventricles; Humans; Male; Middle Aged; Phonocardiography; Physical Exertion; Pulse; Reflex; Sympathetic Nervous System; Time Factors; Venous Pressure

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

Topics: Adult; Digoxin; Echocardiography; Female; Heart; Heart Valve Diseases; Heart Ventricles; Humans; Lidocaine; Male; Middle Aged

Topics: Abortion, Therapeutic; Adult; Aortic Valve Insufficiency; Chronic Disease; Digoxin; Drug Combinations; Female; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Long-Term Care; Lynestrenol; Mestranol; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular

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

Topics: Adult; Aged; Coronary Disease; Digoxin; Diuresis; Female; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Pulmonary Heart Disease; Radiography

Topics: Adult; Aortic Valve; Atrial Fibrillation; Digoxin; Female; Heart Failure; Heart Rate; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve Stenosis; Propranolol; Rheumatic Heart Disease; Sympatholytics

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

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Coronary Disease; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

Topics: Brain Diseases; Chloramphenicol; Chlorothiazide; Digoxin; Diuretics; Drug Therapy; Endocarditis; Endocarditis, Bacterial; Erysipelothrix; Heart Failure; Heart Valve Diseases; Humans; Methicillin; Organomercury Compounds; Penicillin V; Penicillins; Probenecid; Sepsis

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

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