digoxin and Lung-Diseases

Na,K-ATPase (sodium pump; EC 3.6.1.37) is present in the membrane of most eukaryotic cells and controls directly or indirectly many essential cellular functions. Regulation of this enzyme (ion transporter) and its individual isoforms is believed to play a key role in the etiology of some pathological processes. The sodium pump is the only known receptor for the cardiac glycosides. However, endogenous ligands structurally similar to digoxin or ouabain may control the activity of this important molecular complex. Here we review the structure and function of Na,K-ATPase, its expression and distribution in tissues, and its interaction with known ligands such as the cardiac glycosides and other suspected endogenous regulators. Also reviewed are various disorders, including cardiovascular, neurological, renal, and metabolic diseases, purported to involve dysfunction of Na,K-ATPase activity. The escalation in knowledge at the molecular level concerning sodium pump function foreshadows application of this knowledge in the clinical laboratory to identify individuals at risk for Na,K-ATPase-associated diseases.

Topics: Cardiac Glycosides; Cardiovascular Diseases; Digoxin; Fetus; Humans; Lung Diseases; Metabolic Diseases; Nervous System Diseases; Sodium-Potassium-Exchanging ATPase; Structure-Activity Relationship

A case of bilateral neoplastic pulmonary amyloidosis is presented and discussed. The diagnosis was based on the results of a lung biopsy; and laboratory methods of great utility in this pathology were used. Of particular importance are the indications which can be obtained through subcutaneous biopsies and the biochemical test for digoxinemia.

Topics: Amyloidosis; Biopsy, Needle; Digoxin; Humans; Lung; Lung Diseases; Male; Medigoxin; Middle Aged; Radionuclide Imaging

Topics: Benzothiadiazines; Diagnosis, Differential; Digoxin; Diuretics; Heart Failure; Humans; Hyponatremia; Lung Diseases; Sodium Chloride Symporter Inhibitors; Vascular Resistance; Vasodilator Agents

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

Prophylactic digitalization is still recommended after open lung surgery in order to prevent cardiac arrhythmias in the postoperative period. Since a beneficial effect of this potentially harmful medication is only poorly documented, we conducted a prospective randomized trial. Patients undergoing elective open lung surgery were divided into two groups one of which received digoxin postoperatively, the other not. Randomization was performed independently in three groups with regard to the extent of surgery, i.e. pneumonectomies in patients of any age, (bi-)lobectomies in patients > 50 and other (less extended) operations in patients > 60. Patients who were either too young for either group or who had already taken digoxin before surgery were followed separately. Monitoring was performed continuously in the ICU and conventional ECG was registered after 24, 48 and 72 hours and weekly until dismission.--Cardiac arrhythmias are very frequent in the early postoperative period with a maximum between the third and the fifth postoperative day. Any kind of arrhythmias were present in 19 of 30 patients (63%) compared to 14 of 35 patients (40%) in the control group. Symptomatic arrhythmias that needed treatment occurred in 11.4% of the control group, but in 33.3% of the patients with prophylactic digitalization. We therefore conclude that a general prophylactic digitalization after open lung surgery is not indicated, but that arrhythmias should be treated individually.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Electrocardiography, Ambulatory; Female; Humans; Lung Diseases; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Premedication; Prospective Studies; Thoracotomy

Topics: Acute Kidney Injury; Aged, 80 and over; Atrial Fibrillation; Confusion; Delirium; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Immunoglobulin Fab Fragments; Lung Diseases; Medically Uninsured; Nausea; Poisoning; Radiography, Thoracic; Vomiting

The isoprenoid pathway is a key regulatory pathway in the cell. It synthesizes digoxin, an endogenous membrane Na(+)-K+ ATPase inhibitor and modulator of synaptic transmission. The role of the isoprenoid pathway in lung diseases and its relation to hemispheric dominance was assessed in this study. The following parameters were measured in patients with (i) bronchial asthma, (ii) chronic bronchitis emphysemia, (iii) idiopathic pulmonary fibrosis, (iv) sarcoidosis, and (v) in individuals with right hemispheric, left hemispheric and bihemispheric dominance: 1. plasma HMG CoA reductase, digoxin, dolichol, ubiquinone, and magnesium levels, 2. tryptophan, tyrosine catabolic patterns, 3. free radical metabolism, 4. glycoconjugate metabolism, and 5. membrane composition. In patients with lung disease there was elevated digoxin synthesis, increased dolichol and glycoconjugate levels, and low ubiquinone and elevated free radical levels. The RBC membrane Na(+)-K+ ATPase activity and serum magnesium were decreased. There was also an increase in tryptophan catabolites and reduction in tyrosine catabolites in the serum. There was an increase in cholesterol:phospholipid ratio and a reduction in glycoconjugate level of RBC membrane in these patients. The same biochemical patterns were obtained in individuals with right hemispheric chemical dominance. An upregulated isoprenoid pathway and hyperdigoxinemia are characteristic of lung disease and right hemispheric chemical dominance. Right hemispheric chemical dominance is important in deciding the predisposition to lung disease.

Topics: Adult; Digoxin; Dolichols; Female; Free Radicals; Functional Laterality; Humans; Hypothalamus; Lung Diseases; Magnesium; Male; Middle Aged; Phosphoprotein Phosphatases; Ubiquinone

The isoprenoid pathway produces three key metabolites--endogenous digoxin, dolichol, and ubiquinone. This was assessed in patients with idiopathic pulmonary fibrosis and in individuals of differing hemispheric dominance to find out the role of hemispheric dominance in the pathogenesis of idiopathic pulmonary fibrosis. All 15 cases of interstitial lung disease were right-handed/left hemispheric dominant by the dichotic listening test. The isoprenoidal metabolites--digoxin, dolichol, and ubiquinone, RBC membrane Na(+)-K+ ATPase activity, serum magnesium, tyrosine/tryptophan catabolic patterns, free radical metabolism, glycoconjugate metabolism, and RBC membrane composition--were assessed in idiopathic pulmonary fibrosis as well as in individuals with differing hemispheric dominance. In patients with idiopathic pulmonary fibrosis there was elevated digoxin synthesis, increased dolichol and glycoconjugate levels, and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was an increase in cholesterol phospholipid ratio and a reduction in glycoconjugate level of RBC membrane in patients with idiopathic pulmonary fibrosis. Isoprenoid pathway dysfunction con tributes to the pathogenesis of idiopathic pulmonary fibrosis. The biochemical patterns obtained in interstitial lung disease are similar to those obtained in left-handed/right hemispheric chemically dominant individuals by the dichotic listening test. However, all the patients with interstitial lung disease were right-handed/left hemispheric dominant by the dichotic listening test. Hemispheric chemical dominance has no correlation with handedness or the dichotic listening test. Interstitial lung disease occurs in right hemispheric chemically dominant individuals and is a reflection of altered brain function.

Topics: Adenosine Triphosphatases; Brain Chemistry; Cardenolides; Case-Control Studies; Dichotic Listening Tests; Digoxin; Dolichols; Dominance, Cerebral; Free Radicals; Glycoconjugates; Humans; Hydroxymethylglutaryl CoA Reductases; Hypothalamus; Isoproterenol; Lung Diseases; Magnesium; Middle Aged; Neurotransmitter Agents; Saponins; Ubiquinone

The isoprenoid pathway produces three key metabolites--endogenous digoxin, dolichol, and ubiquinone. This was assessed in patients with systemic sarcoidosis. All l5 patients with sarcoidosis were right-handed/left hemispheric dominant by the dichotic listening test. The pathway was also studied in normal right hemispheric, left hemispheric, and bihemispheric dominant individuals for comparison to find out the role of hemispheric dominance in the pathogenesis of sarcoidosis. In patients with sarcoidosis there was elevated digoxin synthesis, increased dolichol, and glycoconjugate levels, and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was an increase in cholesterol:phospholipid ratio and a reduction in glycoconjugate level of RBC membrane in these patients. The neurotransmitter/digoxin-mediated increased intra cellular calcium induced immune activation, ubiquinone deficiency-related mitochondrial dysfunction/free radical generation, and increased dolichol-related altered glycoconjugate metabolism/endogenous self-glycoprotein antigen generation are crucial to the pathogenesis of sarcoidosis. The biochemical patterns obtained in sarcoidosis are similar to those obtained in left-handed/right hemispheric chemically dominant individuals by the dichotic listening test. But all the patients with sarcoidosis were right-handed/left hemispheric dominant by the dichotic listening test. Hemispheric chemical dominance has no correlation with handedness or the dichotic listening test. Sarcoidosis occurs in right hemispheric chemically dominant individuals and is a reflection of altered brain function.

Topics: Adult; Dichotic Listening Tests; Digoxin; Dolichols; Dominance, Cerebral; Female; Humans; Hypothalamus; Lung Diseases; Male; Sarcoidosis; Ubiquinone

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

To examine the relationship between administration of selected medications and falls experienced by hospitalized elderly patients. Benzodiazepines and other medications previously associated with falls in elderly patients residing in the community and nursing homes were the primary focus.. Retrospective case control.. Private, not-for-profit, 575-bed acute care hospital.. A total of 100 patients who had fallen and 100 control patients, aged at least 70 years, admitted during the same 17-month time period.. We examined the relationship between falls and patient demographics, underlying disease states, number of concurrent disease states, and length of hospitalization. Possible associations between the administration of narcotics, benzodiazepines, antidepressants, antipsychotics, other sedating agents, antihypertensives, diuretics, nitrates, and digoxin 48 hours prior to the fall or reference day were explored. The relationships between benzodiazepine half-life, dosage, administration frequency, cumulative dose, and falls were also examined.. Demographically the groups were similar except that patients who had fallen were hospitalized significantly longer (mean 18.8 vs 12.2 d; p < 0.00001) than control patients. Benzodiazepines were received by more (40% vs 20%, odds ratio = 2.67) patients who had fallen than control patients. The use of long (> 24 h) half-life benzodiazepines was similar in patients who had fallen (48%) and control patients (45%). Long half-life benzodiazepines were commonly administered (65%) to patients who had fallen in doses greater than that recommended for the elderly. Benzodiazepine use, expressed as milligrams of diazepam equivalents received during the 48-hour study, was higher in patients who had fallen than in control patients (15.00 +/- 17.80 vs 9.73 +/- 6.58 mg), but this was not statistically significant (p = 0.1030). Congestive heart failure (37% vs 24%), digoxin therapy (35% vs 22%), or administration of 3 or more psychoactive agents (17% vs 4%) were all more common in patients who had fallen than in control patients.. Falls experienced by the elderly patients in our acute care institution were associated with the presence of congestive heart failure along with digoxin therapy, benzodiazepine use, or the use of at least 3 psychoactive agents.

Topics: Accidental Falls; Aged; Aged, 80 and over; Benzodiazepines; Cardiovascular Diseases; Case-Control Studies; Diabetes Mellitus; Digoxin; Diuretics; Female; Half-Life; Heart Failure; Hospital Bed Capacity, 500 and over; Hospitalization; Humans; Hypnotics and Sedatives; Inpatients; Length of Stay; Lung Diseases; Male; Pharmaceutical Preparations; Psychotropic Drugs; Retrospective Studies; United States

Because global T wave inversion has not been specifically characterized, 100 electrocardiograms (ECGs) with this pattern (frontal plane T vector -100 degrees to -170 degrees with precordial T inversion) were prospectively collected from approximately 30,000 consecutively interpreted ECGs and analyzed blindly. There was a striking female predominance (82 women vs. 18 men; p less than 0.0005) despite an essentially equal number of female and male hospital admissions. There was a single statistically significant ECG correlate: a more vertical QRS axis in women (+14.1 degrees +/- 45.3 degrees vs. -5.6 degrees +/- 31.3 degrees; p = 0.034). The T waves were basically symmetric (68%), the influence of this factor usually altering the characteristically asymmetric T wave inversions of right bundle branch block (4 of 5) and left ventricular hypertrophy (21 of 36). Asymmetry was mainly associated with digoxin therapy (21 of 32 patients taking digoxin; p less than or equal to 0.0005) and a corrected QT (QTc) interval (0.433 +/- 0.095) shorter than with symmetric T wave inversions (0.507 +/- 0.074; p less than or equal to 0.0005) though not reaching the degree of shortening expected for digitalization. Twenty-eight patients admitted for acute myocardial infarction and 23 for a central nervous system disorder accounted for the majority of patients with symmetric T wave inversion. Fifteen of 18 patients who had coronary angiography had some degree of coronary artery disease: 3 had angiographically normal coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Age Factors; Bundle-Branch Block; Cardiomegaly; Central Nervous System Diseases; Digoxin; Electrocardiography; Female; Gastrointestinal Diseases; Heart; Humans; Lung Diseases; Male; Metabolic Diseases; Myocardial Infarction; Sex Factors

Arrhythmias often complicate the course of patients with severe respiratory disease; the frequency of arrhythmias in patients with this condition approaches that seen with acute myocardial infarction. No one rhythm disturbance predominates, but rapid atrial and ventricular rhythms are characteristic. In the setting of acute respiratory failure, several conditions may predispose to arrhythmias. Hypoxemia, a serum pH that is too high or too low, and a low serum potassium may produce arrhythmias by disturbing the myocardial cellular milieu. Drugs such as digitalis, epinephrine, and theophylline may also act as myocardial irritants. The first step in therapy is to careful examination, it is helpful to note the specific effect of the arrhythmia on the patient. Some rhythm disturbances are well tolerated, while others are associated with serious problems in ventilation and perfusion. In many cases the control of respiration, correction of pH and electrolyte imbalance, and provision of bronchial hygiene will restore a normal sinus rhythm. Such measures are essential even when antiarrhythmic drugs or cardioversion are needed.

Topics: Arrhythmias, Cardiac; Chronic Disease; Digoxin; Humans; Hypokalemia; Hypoxia; Lidocaine; Lung Diseases; Oxygen Inhalation Therapy; Procainamide; Propranolol; Pulmonary Atelectasis; Quinidine

Topics: Alcoholism; Brain Neoplasms; Digoxin; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Humans; Hypertension, Renal; Iodine Radioisotopes; Lung Diseases; Mammography; Mass Screening; Models, Theoretical; Pelvimetry; Prognosis; Radionuclide Imaging

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: Adult; Anticoagulants; Autopsy; Cardiac Catheterization; Digoxin; Female; Hematoma; Hemorrhage; Humans; Lung Diseases; Pulmonary Artery; Quinidine; Rupture; Warfarin

Topics: Aged; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Lung Diseases; Male; Middle Aged; Myocardial Infarction; Quinidine; Time Factors

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: Adolescent; Adult; Age Factors; Aged; Alcohol Drinking; Anti-Bacterial Agents; Candida; Child; Chronic Disease; Digoxin; Female; Fungi; Humans; Lung Diseases; Male; Middle Aged; Mitosporic Fungi; Pharynx; Seasons; Sex Factors; Smoking; South Africa; Statistics as Topic; Steroids

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Lung Diseases; Male; Myocardial Infarction; Poisoning; Prognosis; Prospective Studies; Radioimmunoassay

Topics: Age Factors; Arteriosclerosis; Atrial Fibrillation; Body Weight; Digoxin; Edema; Female; Heart Failure; Heart Rate; Humans; Hypertension; Lung Diseases; Male; Middle Aged; Organ Size; Spirometry; Syphilis, Cardiovascular

Topics: Asthma; Biomedical Research; Blood Pressure; Blood Pressure Determination; Bronchitis; Cardiac Catheterization; Digitalis; Digoxin; Electrocardiography; Eosinophilia; Humans; Lung Diseases; Pharmacology; Pulmonary Artery; Pulmonary Emphysema

Topics: Chlorambucil; Chloramphenicol; Cytomegalovirus Infections; Diagnosis, Differential; Digoxin; Electrons; Hodgkin Disease; Humans; Hydrocortisone; Infant; Lung Diseases; Mechlorethamine; Microscopy; Microscopy, Electron; Neoplasms; Pathology; Penicillins; Plasma Cells; Pneumonia; Pneumonia, Pneumocystis; Streptomycin

Topics: Bronchial Diseases; Digitalis; Digitalis Glycosides; Digoxin; Heart Failure; Humans; Lung Diseases