digoxin and Hypotension

Topics: Action Potentials; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digitalis Glycosides; Digoxin; Fever; Heart Atria; Heart Block; Humans; Hypotension; Lung Diseases, Obstructive; Methoxamine; Pacemaker, Artificial; Procainamide; Propranolol; Pulmonary Embolism; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation

Topics: Abortion, Septic; Acute Kidney Injury; Analgesics; Angiotensin II; Animals; Anti-Bacterial Agents; Antihypertensive Agents; Catecholamines; Digoxin; Disseminated Intravascular Coagulation; Diuretics; Dogs; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Hypotension; Kidney; Kidney Concentrating Ability; Kidney Cortex Necrosis; Pregnancy; Pregnancy Complications, Infectious; Prostaglandins; Rabbits; Renal Dialysis; Renin; Sepsis; Shock, Septic; Sympathetic Nervous System; Tranquilizing Agents; Water-Electrolyte Balance

The efficacy and safety of intravenous flecainide to convert recent-onset atrial fibrillation (AF) (present for greater than or equal to 30 minutes and less than or equal to 72 hours and a ventricular response greater than or equal to 120 beats/min) was investigated. A total of 102 patients without severe heart or circulatory failure were randomized to receive either intravenous flecainide (2 mg/kg, maximum dose 150 mg; 51 patients) or placebo (51 patients) in a double-blind trial. Digoxin (500 micrograms intravenously) was administered to all patients who had not previously been receiving digoxin. The electrocardiogram was monitored continuously during the study. In 29 (57%) patients stable sinus rhythm was restored within 1 hour after flecainide and in only 7 (14%) given placebo (chi square 18.9; p = 0.000013; odds ratio 8.3; 95% confidence interval 2.9-24.8). Reversion to sinus rhythm within 1 hour after starting the trial medication was considered a pretrial end point and likely to be due to a drug effect. At the end of the 6-hour monitoring period, 34 patients (67%) in the flecainide group were in sinus rhythm whereas only 18 (35%) in the placebo group had reverted (chi square 8.83, p = 0.003; odds ratio 3.67; 95% confidence interval 1.5-9.1). Significant hypotension, although short lived, was more common in the flecainide group. One patient given flecainide developed torsades de pointes and was successfully electrically cardioverted. Flecainide is useful for the management of recent-onset AF both for control of the ventricular response and conversion to sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Double-Blind Method; Drug Evaluation; Female; Flecainide; Humans; Hypotension; Male; Middle Aged; Monitoring, Physiologic; Time Factors

Spontaneous reversion to sinus rhythm is a frequent occurrence in recent-onset atrial fibrillation (AF). In a randomized, double-blind, controlled study, intravenous flecainide (2 mg/kg, maximum dose 150 mg) was compared with placebo in the treatment of recent-onset AF (present for greater than or equal to 30 minutes and less than or equal to 72 hours' duration and a ventricular response greater than or equal to 120 beats/min). Intravenous digoxin (500 micrograms) was administered concurrently to all patients in both groups who had not previously taken digoxin. The trial medication was administered over 30 minutes. Exclusion criteria included hemodynamic instability, severe heart failure, recent antiarrhythmic therapy, hypokalemia and pacemaker dependence. One hundred two consecutive patients with recent-onset AF were enrolled in the study. All patients underwent continuous electrocardiographic monitoring in the intensive care or coronary care unit. Twenty-nine (57%) patients given flecainide and digoxin, but only 7 (14%) given placebo and digoxin, reverted to sinus rhythm in less than or equal to 1 hour after starting the trial medication infusion and remained in stable sinus rhythm (chi-square 18.9, p = 0.000013; odds ratio 8.3, 95% confidence interval 2.9 to 24.8). At the end of the 6-hour monitoring period, 34 patients (67%) in the flecainide-digoxin group were in stable sinus rhythm, whereas only 18 patients (35%) in the placebo-digoxin group had reverted (chi-square 8.83, p = 0.003; odds ratio 3.67, 95% confidence interval 1.5 to 9.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Fibrillation; Coronary Care Units; Digoxin; Double-Blind Method; Drug Therapy, Combination; Electrocardiography; Female; Flecainide; Humans; Hypotension; Infusions, Intravenous; Male; Middle Aged

To evaluate the concept that long duration of action is an advantageous property of angiotensin-converting enzyme inhibitors in the treatment of severe heart failure, we randomly assigned 42 patients to therapy with either a short-acting inhibitor (captopril, 150 mg daily) or a long-acting inhibitor (enalapril, 40 mg daily) for one to three months while concomitant therapy with digoxin and diuretics was kept constant. The treatment groups had similar hemodynamic and clinical characteristics at base-line evaluation and similar initial responses to converting-enzyme inhibition. During long-term therapy, captopril and enalapril produced similar decreases in systemic blood pressure, but the hypotensive effects of enalapril were more prolonged and persistent than those of captopril. Consequently, although the patients in both groups improved hemodynamically and clinically during the study, serious symptomatic hypotension (syncope and near syncope) was seen primarily among those treated with enalapril. Sustained hypotension also probably accounted for the decline in creatinine clearance (P less than 0.05) and the notable retention of potassium (P less than 0.05) observed in the patients treated with enalapril but not in those treated with captopril. We conclude that when large, fixed doses of converting-enzyme inhibitors are used in the treatment of patients with severe chronic heart failure, long-acting agents may produce prolonged hypotensive effects that may compromise cerebral and renal function, and thus they may have disadvantages in such cases, as compared with short-acting agents.

Topics: Adult; Aged; Blood Pressure; Captopril; Chronic Disease; Clinical Trials as Topic; Creatinine; Digoxin; Diuretics; Drug Therapy, Combination; Electrolytes; Enalapril; Female; Heart Failure; Hemodynamics; Humans; Hypotension; Male; Middle Aged; Random Allocation

We describe the case of a patient on continuous venovenous hemodiafiltration with atrial fibrillation with rapid ventricular response and hypotension requiring vasopressor use, which warranted digoxin therapy. In the absence of guidelines specifying appropriate digoxin dosing in patients undergoing continuous venovenous hemodiafiltration, anecdotal evidence-guided digoxin dosing was performed for this patient using plasma digoxin concentration-based therapeutic drug monitoring. We use this case to demonstrate the potential role of physiologically based pharmacokinetic modeling in assisting therapeutic decision making.

Topics: Aged; Atrial Fibrillation; Body Weight; Cardiotonic Agents; Continuous Renal Replacement Therapy; Digoxin; Drug Dosage Calculations; Drug Monitoring; Hemodiafiltration; Humans; Hypotension; Kidney Function Tests; Male; Models, Biological; Point-of-Care Systems; Renal Insufficiency

The purpose of this study was to report the efficacy of intravenous amiodarone alone or in combination with digoxin in neonates and small infants with life-threatening supraventricular tachyarrhythmia (SVT).. We retrospectively analyzed 9 neonates and small infants with life-threatening or resistant SVT who were treated with intravenous amiodarone alone or in combination with digoxin.. This report consists of 8 patients with reentrant SVT and 1 with atrial flutter. On admission, 7 patients had a congestive heart failure and 3 of whom had cardiovascular collapse. Intravenous rapid bolus of adenosine caused a sustained sinus rhythm in 4 patients. These patients were given digoxin initially, but recurrence of persistent tachyarrhythmia necessitated the use of intravenous amiodarone in all these patients. Amiodarone was given initially to the other 4 patients in whom adenosine caused only temporary conversion to the sinus rhythm. It was effective in 2 patients. In the other 2, digoxin was added to therapy for tachycardia control. Amiodarone alone or in combination with digoxin effectively controlled reentrant SVT in all patients. This combined treatment caused ventricular rate control in patient with atrial flutter, and conversion to the stable sinus rhythm was achieved at approximately 8 months.. Intravenous amiodarone alone or in combination with digoxin was found to be safe and effective in controlling refractory and life-threatening SVT in neonates and small infants.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Evaluation; Drug Therapy, Combination; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Failure; Heart Neoplasms; Heart Rate; Humans; Hypotension; Infant; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Male; Retrospective Studies; Rhabdomyoma; Shock, Cardiogenic; Tachycardia, Supraventricular; Thyrotropin; Treatment Outcome

We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng/mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent Digoxin immunoassay reagent antibodies.. Plant extracts from V. viride demonstrated cross-reactivity to Multigent reagent antibodies but did not bind therapeutic DigiFab antibodies. Gas chromatography/mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman.. This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab fragments as an antidote in symptomatic V. viride toxic patients.

Topics: Biological Assay; Bradycardia; Chemistry, Clinical; Cross Reactions; Digoxin; Eating; Humans; Hypotension; Immunoassay; Immunoglobulin Fab Fragments; Nausea; Plant Extracts; Plants; Veratrum; Veratrum Alkaloids; Vomiting

The prevalence of stroke is increased in individuals with heart failure (HF). The stroke mechanism in HF may be cardiogenic embolism or cerebral hypoperfusion. Stroke risk increases with decreasing ejection fraction and low cardiac output is associated with hypotension and poor survival. We examine the relationship among blood pressure level, history of stroke/transient ischemic attack (TIA), and HF.. We compared the prevalence of self-reported history of stroke or TIA in the REasons for Geographic And Racial Differences in Stroke (REGARDS) participants with HF (as defined by current digoxin use) and without HF. We excluded participants with atrial fibrillation or missing data. We examined the relationship between HF and history of stroke/TIA within tertiles of systolic blood pressure (SBP) adjusting for patient demographic and health characteristics.. Prevalent stroke/TIA were reported by 66 (26.3%) of 251 participants with and 1805 (8.5%) of 21 202 participants without HF (P<0.0001). Within each tertile of SBP, the unadjusted OR (95% CI) for prior stroke/TIA among those with HF compared with those without HF (the reference group) was, 4.0 (2.8 to 5.8) for SBP <119.5 mm Hg, 2.7 (1.8 to 3.9) for SBP >or=119.5 but <131.5 mm Hg, and 2.3 (1.6 to 3.2) for SBP >or=131.5 mm Hg. After adjustment, the relationship between prior stroke/TIA and HF remained significant only within the lowest tertile of SBP (<119.5 mm Hg; 3.0; 1.5 to 6.1).. The odds of prevalent self-reported stroke/TIA are increased in participants with HF and most markedly increased in participants with low SBP. Longitudinal data are needed to determine whether this reflects stroke/TIA secondary to thromboembolism from poor cardiac function or secondary to cerebral hypoperfusion.

Topics: Aged; Aged, 80 and over; Biomarkers; Black People; Blood Pressure; Cohort Studies; Comorbidity; Digoxin; Female; Geography; Heart Failure; Humans; Hypotension; Ischemic Attack, Transient; Male; Medical History Taking; Middle Aged; Odds Ratio; Prevalence; Racial Groups; Risk Factors; Stroke; Surveys and Questionnaires; White People

We report here the successful treatment of a 16-year-old female who ingested 20 tablets of digoxin each containing 0.25 mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300 mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.

Topics: Adolescent; Anti-Arrhythmia Agents; Anticoagulants; Bradycardia; Cytochrome P-450 Enzyme System; Digoxin; Drug Overdose; Enzyme Induction; Female; Humans; Hypotension; Plasma Exchange; Propafenone; Rifampin; Warfarin

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Bradycardia; Digoxin; Drug Interactions; Electrocardiography; Female; Humans; Hypotension; Middle Aged; Sotalol; Time Factors; Verapamil

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

Herbal dietary supplements are often considered by patients to be safe and free from side effects. The case described here shows digoxin toxicity in a patient taking a dietary supplement not normally considered to contain digoxin. In addition to highlighting the risks of herbal supplements, this case also demonstrates the concept that digoxin equivalents are not picked up by the standard digoxin assay.

Topics: Adult; Bradycardia; Digoxin; Female; Humans; Hypotension; Immunoassay; Plants, Medicinal; Stress, Psychological

Topics: Adrenergic beta-Antagonists; Angioedema; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Chronic Disease; Digoxin; Diuretics; Dose-Response Relationship, Drug; Heart Failure; Humans; Hypokalemia; Hypotension; Spironolactone; Vasodilator Agents

During February 1993-May 1995, the New York City Poison Control Center (NYCPCC) was informed about onset of illness in five previously healthy men after they ingested a substance marketed as a topical aphrodisiac; four of the men died. These cases were investigated by the New York City Department of Health, the New York City Department of Environmental Protection, and the Food and Drug Administration (FDA). Four cases were referred to the NYCPCC and one case to the New York City medical examiner's office. The decedents died from cardiac dysrhythmias, and all five patients had measurable levels of digoxin* detected in their serum. Digoxin had not been prescribed for therapeutic purposes for any of these patients, and none had medical conditions associated with endogenous digoxin-like immunoreactive substances. The purported aphrodisiac contains bufadienolides, naturally occurring cardioactive steroids that have digoxin-like effects. This report describes three of the five case reports, summarizes the investigations of the five cases, and underscores the health risks associated with inappropriate use of preparations containing digoxin-like substances.

Topics: Adolescent; Adult; Aphrodisiacs; Arrhythmias, Cardiac; Bufanolides; Digoxin; Fatal Outcome; Heart Arrest; Humans; Hyperkalemia; Hypotension; Male; New York City; Poisoning

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Bufanolides; Digoxin; Fatal Outcome; Heart Arrest; Humans; Hyperkalemia; Hypotension; Male; New York City; Poisoning

Topics: Digoxin; Drug Interactions; Humans; Hypotension; Propranolol; Tachycardia, Supraventricular; Verapamil

Intravenous verapamil hydrochloride was used alone in 63 episodes of atrial fibrillation and flutter and six episodes of supraventricular tachycardia (SVT) (group A). Calcium chloride was given intravenously prior to verapamil in 41 episodes of fibrillation and flutter and 18 episodes of SVT (group B). All patients with SVT converted to normal sinus rhythm, with eight in group B converting after administration of calcium alone. Therapy lowered the heart rate in all patients with fibrillation and flutter; however, those given verapamil alone had a mean decrease in systolic pressure of 18.8 mm Hg; there was no change in those pretreated with calcium. The mean dose of verapamil required by group B was significantly lower than in group A. Many with atrial fibrillation or flutter who received digoxin subsequently converted to sinus rhythm. Thus, pretreatment with calcium decreased the hypotensive effect of verapamil without compromising its antiarrhythmic effect.

Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Atrial Flutter; Calcium Chloride; Digoxin; Drug Evaluation; Drug Interactions; Drug Therapy, Combination; Female; Hemodynamics; Humans; Hypotension; Infusions, Parenteral; Male; Middle Aged; Premedication; Verapamil

Prompt control of heart rate is important for successful treatment of supraventricular tachyarrhythmias early after open heart surgery when sympathetic tone is high and ventricular response rates may be rapid. Esmolol, a new ultrashort-acting (9 minute half-life) beta-receptor blocking agent, was given by continuous intravenous infusion for up to 24 hours in 24 patients (21 with isolated coronary bypass surgery and 3 with valve replacement) 1 to 7 days after surgery. Atrial fibrillation was present in 9 patients, atrial flutter in 2 and sinus tachycardia in 13. Eleven patients had received intravenous digoxin (average dose 0.6 mg, average serum level 1.19 mg/100 ml) before esmolol infusion without adequate control of the supraventricular tachyarrhythmia. After a 1 minute loading infusion of esmolol (500 micrograms/kg per min), maintenance dose, titrated to heart rate and blood pressure response, varied from 25 to 300 micrograms/kg per min. After esmolol administration, at an average dose of 139 +/- 83 micrograms/kg per min, mean heart rate decreased from 130 +/- 15 to 99 +/- 15 beats/min. Within 5 to 18 minutes after initiation of therapy, all patients had achieved a 15% reduction in heart rate at a maintenance dose of 150 micrograms/kg per min or less. A 20% reduction in heart rate was attained in 19 of the 24 patients, and conversion to sinus rhythm occurred during esmolol infusion in 5 of the 11 patients with atrial flutter or fibrillation. Transient asymptomatic hypotension (less than 90/50 mm Hg) was seen in 13 patients, requiring cessation of esmolol therapy in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Blood Pressure; Cardiac Surgical Procedures; Digoxin; Dose-Response Relationship, Drug; Heart Rate; Humans; Hypotension; Infusions, Parenteral; Middle Aged; Postoperative Complications; Premedication; Propanolamines; Tachycardia

Of 1,247 consecutive patients who underwent cardiac surgery, 297 (24%) developed a post-operative atrial tachyarrhythmia. Of these patients, 201 were suitable for treatment according to the study protocol. All patients were initially given digoxin 0.75 mg intravenously (i.v.). After two hours, those 156 patients whose atrial arrhythmias persisted were given a 2 mg/kg loading dose of disopyramide (i.v.), followed by a constant i.v. infusion (0.4 mg kg-1 h-1) or oral therapy (600 mg daily). Within a further 12 hours, 75 patients (48%) reverted to sinus rhythm, 24 within one hour. Thus 120/201 patients (60%) reverted to sinus rhythm within 14 hours of commencing therapy. Reversion rates of those patients with both atrial fibrillation and flutter (AF/AFL) were significantly lower than those with AF (p less than 0.001) or AFL (p less than 0.02) alone. A further 70 patients reverted to sinus rhythm in one to 13 (mean four) days on continued drug therapy. Elective cardioversion restored sinus rhythm in six subjects. Atrial arrhythmias persisted in five patients (2.5%) at hospital discharge. Side-effects of disopyramide were noted in 19% of patients. Urinary retention was common (11.5%). Four patients with atrial flutter developed 1:1 atrioventricular conduction with the disopyramide loading dose. One patient with atrial fibrillation developed ventricular tachycardia during injection of the loading dose of disopyramide, but was successfully cardioverted to sinus rhythm. Two further patients developed significant hypotension (less than 90 mmHg systolic). Disopyramide is effective in the treatment of post-operative atrial tachyarrhythmias, but its routine use in this situation may be associated with an unacceptably high incidence of side-effects.

Topics: Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Disopyramide; Drug Therapy, Combination; Heart Conduction System; Humans; Hypotension; Postoperative Complications; Urination Disorders

Topics: Acute Kidney Injury; Adult; Aged; Arrhythmias, Cardiac; Diabetes Mellitus; Digoxin; Female; Half-Life; Hemoperfusion; Humans; Hypotension; Kidney Failure, Chronic; Male; Middle Aged; Polystyrenes; Polyvinyls; Renal Dialysis

Toxicity from cardiac drugs is a particular management challenge since the manifestations of an acute overdose and the initial indications for the drug are often similar. Plasma drug levels are essential but must be interpreted in light of the clinical picture. Hypotension, due to either vasodilatation or decreased myocardial contractility, and arrhythmias are the principal cardiac manifestations, but noncardiac effects are sometimes more troublesome. An antiarrhythmic agent of the same class should not be used in treating an arrhythmia resulting from an overdose.

Topics: Arrhythmias, Cardiac; Bretylium Compounds; Cardiovascular Agents; Cardiovascular Diseases; Digoxin; Disopyramide; Humans; Hypotension; Lidocaine; Liver; Phenytoin; Procainamide; Propranolol; Quinidine; Vasodilator Agents

The probability of experiencing adverse drug reactions increases with age. Polypharmacy, pharmacokinetic changes (altered drug distribution, reduced renal and hepatic drug clearances), unusual pharmacological effects and impaired compensatory mechanisms are the principal reasons for the diminished tolerance of elderly patients to several drugs. Especially neuroleptics, antidepressants, tranquilizers, digoxin, potent diuretics, betablockers, and antiarrhythmics have to be employed with special care. To prevent adverse reactions in geriatric patients, prescriptions should be limited to a few essential drugs, dosage reduced, and dosing regimens simplified. However, therapeutic nihilism can never be justified by old age alone.

Topics: Acute Kidney Injury; Adrenergic beta-Antagonists; Aged; Antidepressive Agents; Antipsychotic Agents; Arrhythmias, Cardiac; Benzodiazepines; Creatine; Digoxin; Diuretics; Drug-Related Side Effects and Adverse Reactions; Female; Geriatrics; Humans; Hypotension; Male

Topics: Analgesics; Atropine; Digoxin; Dobutamine; Dopamine; Drug Therapy, Combination; Heart Failure; Heart Rupture; Hemodynamics; Humans; Hypertension; Hypotension; Myocardial Infarction; Propranolol; Shock, Cardiogenic; Vasodilator Agents

This study was undertaken to investigate the effect of intravenous acetylstrophanthidine and digoxin on the gracilis vascular resistance of hypotensive dogs. The gracilis muscle was isolated and separately perfused, but the nerve to the muscle was left intact. Acetylstrophanthidin, 0.5 mg iv, and digoxin, 1.0 mg iv, both produced a sustained vasodilator response in the gracilis vascular bed of all the hypotensive animals (mean arterial pressure 50 mmHg). A short-lasting vasoconstriction preceded the vasodilation in response to acetylstrophanthidin in 6 of the 8 animals. Prior local alpha-adrenergic blockade with phenoxybenzamine did not have any significant effect on vasodilation. Prior local cholinergic receptor blockade with atropine, however, abolished the sustained vasodilator response, thus indicating that the mechanism responsible for this neurogenic effect is cholinergic. In contrast, in the normotensive dogs, the response to intravenously administered digoxin was sustained vasoconstriction, which was abolished by prior local alpha-adrenergic receptor blockade. Thus, the effect of digitalis glycosides on peripheral vascular resistance is importantly affected by the background level of sympathetic activity.

Topics: Animals; Atropine; Blood Pressure; Digoxin; Dogs; Female; Hypotension; Male; Muscles; Phenoxybenzamine; Strophanthidin; Vascular Resistance

Topics: Aortic Valve; Cardiac Catheterization; Cardiomyopathy, Hypertrophic; Chlordiazepoxide; Digitalis Glycosides; Digoxin; Female; Heart Block; Humans; Hydrochlorothiazide; Hypotension; Middle Aged; Phonocardiography; Pulse

Topics: Arrhythmias, Cardiac; Atropine; Diet Therapy; Digoxin; Electrocardiography; Female; Furosemide; Heart Block; Heart Failure; Heparin; Hospitalization; Humans; Hypotension; Male; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Oxygen Inhalation Therapy; Progressive Patient Care; Shock, Cardiogenic

Topics: Arrhythmias, Cardiac; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Arrest; Heart Block; Hemorrhage; Humans; Hypotension; Infant; Male; Methods; Postoperative Complications; Propranolol; Transposition of Great Vessels

Topics: Aged; Analgesia; Anti-Arrhythmia Agents; Blood Volume; Bradycardia; Cardiovascular Diseases; Diazepam; Digoxin; Diuretics; Dopamine; Glucagon; Heart Failure; Humans; Hypertension; Hypotension; Male; Myocardial Infarction; Norepinephrine; Phentolamine; Plasma Substitutes; Potassium; Tachycardia

Topics: Adult; Aged; Antidepressive Agents; Antiemetics; Digoxin; Dihydroxyphenylalanine; Diuretics; Drug Antagonism; Drug Synergism; Female; Guanethidine; Humans; Hypertension; Hypnotics and Sedatives; Hypoglycemic Agents; Hypotension; Male; Middle Aged; Nausea; Parkinson Disease; Pyridoxine; Time Factors

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

Topics: Abortion, Septic; Adult; Blood Pressure; Cardiac Catheterization; Cardiac Output; Central Venous Pressure; Computers; Digoxin; Female; Hemodynamics; Humans; Hypotension; Isoproterenol; Oxygen Consumption; Pregnancy; Puerperal Disorders; Regional Blood Flow; Sepsis; Shock, Septic; Vascular Resistance; Vasodilator Agents

Topics: Aged; Arrhythmias, Cardiac; Aspartate Aminotransferases; Biophysical Phenomena; Biophysics; Blood Flow Velocity; Blood Pressure; Cardiac Output; Coronary Disease; Digoxin; Electrocardiography; Heart; Heart Failure; Humans; Hydrocortisone; Hypotension; Isoproterenol; Lidocaine; Male; Methyldopa; Middle Aged; Models, Biological; Propranolol; Stress, Psychological; Veins

Topics: Aminophylline; Digoxin; Diuretics; Drug Therapy; Electric Countershock; Electrocardiography; Heart Failure; Humans; Hypotension; Metaraminol; Myocardial Infarction; Organomercury Compounds; Phenylephrine; Quinidine; Tachycardia; Ventricular Fibrillation

Topics: Adrenergic Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Electrocardiography; Ethanolamines; Geriatrics; Heart Block; Heart Failure; Hypotension; Myocardial Infarction; Nausea; Paresthesia; Sympatholytics; Toxicology; Vertigo; Vomiting