digoxin and Mitral-Valve-Insufficiency

ACC Stage C heart failure includes those patients with prior or current symptoms of heart failure in the context of an underlying structural heart problem who are primarily managed with medical therapy. Although there is guideline-based medical therapy for those with heart failure with reduced ejection fraction (HFrEF), therapies in heart failure with preserved ejection fraction (HFpEF) have thus far proven elusive. Emerging therapies such as serelaxin are currently under investigation and may prove beneficial. The role of advanced surgical therapies, such as mechanical circulatory support, in this population is not well defined. Further investigation is warranted for these therapies in patients with Stage C heart failure.

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiac Resynchronization Therapy; Cardiotonic Agents; Coronary Artery Bypass; Defibrillators, Implantable; Diet, Sodium-Restricted; Digoxin; Diuretics; Exercise Therapy; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Mitral Valve Insufficiency; Obesity; Patient Compliance; Patient Education as Topic; Sleep Apnea, Obstructive; Vasodilator Agents

The use of vasodilator therapy in chronic AR and MR may be beneficial in selected patients and harmful in others. The hemodynamics of the two conditions are different and must be taken into account. In AR, vasodilators reduce afterload mismatch and can preserve LV function and delay the need for surgery. However, if the patient has severely reduced diastolic blood pressure, vasodilators could potentially impair coronary perfusion. In MR, vasodilators may reduce regurgitant volume and LV preload depending on the mechanism of MR. In patients with MR caused by dilated cardiomyopathy, vasodilators reduce symptoms, and improve functional class. However, in mitral valve prolapse or hypertrophic cardiomyopathy, vasodilators may worsen the MR and should be avoided. In other primary causes of MR, vasodilators could potentially mask the development of LV dysfunction and lead to unnecessary and harmful delays in surgery.

Topics: Aortic Valve Insufficiency; Chronic Disease; Digoxin; Heart Ventricles; Hemodynamics; Humans; Mitral Valve Insufficiency; Nifedipine; Survival Rate; Vasodilator Agents

This study was designed for quantification of mitral regurgitation by echocardiographic measurements such as regurgitant volume (RV), regurgitant fraction (RF) and effective regurgitant orifice area (EROA), and to assess the effect of angiotensin converting enzyme inhibitor (ACEI) therapy on these measurements.. Patients with rheumatic mitral insufficiency were divided into two groups: Study group (SG)-10 females, 2 males, aged 10-18 years, body surface area 1.49+/-0.05 m2, receiving digoxin therapy for at least one year and Control group (CG)-8 females, 4 males, aged 8-17 years, body surface area 1.38+/-0.07 m2, with no treatment. Patients in the two groups had no symptoms of cardiac failure. Angiotensin converting enzyme inhibitor therapy was given to SG patients on admission. Echocardiographic examinations were applied on admission and at the 20th day of therapy with ACEI and digoxin.. Study group's left ventricular end-diastolic volume (108.03+/-41.21 ml/m2), mitral stroke volume (510.37+/-321.58 ml/m2) and regurgitant volume (423.48+/-305.00 ml/m2) were significantly higher (p<0.05) on admission than in the CG (81.98+/-21.53 ml/m2, 315.34+/-207.38 ml/m2 and 245.77+/-179.84 ml/m2, respectively). Aortic stroke volume at the 20th day of therapy was significantly higher in SG than in the CG. Therapy with ACEI decreased significantly SG's left ventricular end-diastolic volume.. Angiotensin converting enzyme inhibitors should be started at an early stage of mitral regurgitation. The effective regurgitant orifice area is a feasible and easy method for the outpatient follow-up of mitral regurgitation.

Topics: Administration, Oral; Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors; Cardiac Volume; Cardiotonic Agents; Child; Digoxin; Drug Administration Schedule; Echocardiography, Doppler; Enalapril; Female; Humans; Male; Mitral Valve Insufficiency; Prospective Studies; Rheumatic Heart Disease; Stroke Volume; Treatment Outcome

To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR).. We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure.. No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase.. The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Child; Chronic Disease; Digoxin; Double-Blind Method; Enalapril; Female; Humans; Male; Mitral Valve Insufficiency; Systole; Time Factors; Ultrasonography; Ventricular Function, Left

There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency.. To compare digoxin and enalapril in the treatment of heart failure due to mitral insufficiency.. Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmill were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency.. Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76 +/- 168 sec (p = 0.022), whereas this change was not significant with enalapril (38 +/- 158 sec; p = 0.2). With enalapril treatment, ventricular diastolic dimension decreased from 59.3 +/- 8.1 to 58 +/- 9.3 mm and the area of mitral insufficiency decreased from 8.1 +/- 3.5 to 6.6 +/- 3.1 cm2. Digoxin did not induce any significant echocardiographic change.. In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Digoxin; Double-Blind Method; Enalapril; Exercise Tolerance; Female; Heart Failure; Heart Ventricles; Humans; Male; Mitral Valve Insufficiency

To test the long-term effect of enalapril maleate treatment on progression of clinical signs of heart disease in dogs with moderate or severe naturally acquired heart failure associated with chronic degenerative mitral valvular disease (mitral regurgitation [MR]) or dilated cardiomyopathy (DCM).. Prospective multicenter study.. 110 dogs enrolled at 15 locations in the United States.. All dogs enrolled in this study were maintained on their randomly allocated treatment regimen until death, treatment failure (deterioration of condition requiring additional medication), or termination of the study. All dogs entered in the study received standard heart failure treatment (furosemide with or without digoxin). Statistical analysis (log-rank test) was performed to compare the distribution of number of days in the study between dogs that received placebo tablets and dogs that received enalapril tablets.. When dogs with MR and DCM were grouped together, mean number of days until treatment failure was significantly different between those receiving enalapril and those given placebo tablets (157.5 and 77.0 days, respectively). For dogs with MR, mean number of days until treatment failure was significantly different between those receiving enalapril and placebo tablets (159.5 and 86.6 days, respectively). Mean number of days until treatment failure among dogs with DCM receiving enalapril and placebo tablets was 142.8 and 56.5, respectively.. Use of enalapril in combination with standard treatment (diuretics with or without digoxin) appears to be beneficial over an extended period, compared with standard treatment alone.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Cardiomyopathy, Dilated; Cardiotonic Agents; Death, Sudden, Cardiac; Digoxin; Disease Progression; Diuretics; Dog Diseases; Dogs; Double-Blind Method; Drug Therapy, Combination; Enalapril; Female; Furosemide; Heart Failure; Male; Mitral Valve Insufficiency; Prospective Studies; Uremia

34 patients with ventricular dysfunction (18 in NYHA class II and 16 in NYHA class III heart failure) whose clinical status was stabilized by diuretics and systemic vasodilators, entered a randomized trial to compare the effects of short-term oral digoxin and active placebo on left ventricular diastolic function, non invasively evaluated by echo-Doppler transmitral left ventricular filling flow. At baseline patients were subdivided by reversal--the ratio of peak early (E) and late (A) transmitral filling velocities--E/A < 1 (group I) or normal--E/A > or = 1 (group II) echo-Doppler E/A ratio; group II exhibited a shorter deceleration time (125 +/- 20 ms vs 198 +/- 38 ms, p > 0.05) and isovolumic relaxation time (64 +/- 15 ms vs 93 +/- 10 ms; p < 0.05) as well as a higher peak E velocity (85 +/- 28 cm/s vs 54 +/- 20 cm/s; p < 0.05), ("restrictive" left ventricular filling pattern). After 4 weeks, no changes in all echo-Doppler parameters were noted in group I in response to either oral digoxin or active placebo. Clinical amelioration (defined as reduction by at least one functional class) was observed in 3 patients after digoxin.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Animals; Diastole; Digoxin; Double-Blind Method; Echocardiography, Doppler; Female; Guinea Pigs; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Ventricular Function, Left

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

Since both vasculitis syndromes and infective endocarditis may present with multi-system involvement, they can pose a diagnostic dilemma. A 10-year-old boy was admitted with multi-system disease secondary to embolic complications of infective endocarditis. Echocardiography demonstrated mitral valve prolapse and moderate mitral regurgitation with vegetations on the anterior and posterior mitral leaflet. Despite supportive treatment, his general condition deteriorated and he died 3 days after admission.

Topics: Anti-Bacterial Agents; Brain; Cardiotonic Agents; Child; Diagnosis, Differential; Digoxin; Echocardiography; Endocarditis; Fatal Outcome; Humans; Intracranial Embolism; Male; Mitral Valve Insufficiency; Mitral Valve Prolapse; Peritoneal Dialysis; Radiography; Tomography; Vancomycin; Vasculitis

Topics: Adrenergic beta-Antagonists; Cardiomegaly; Digoxin; Diuretics; Female; Heart Atria; Humans; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Tomography, X-Ray Computed; Ultrasonography; Warfarin

A case of a 62-year-old woman presenting with a 20-year history of vulvodynia previously unresponsive to medical treatment is described. The epidemiology, phenomenology and medical management of vulvodynia is reviewed. The case presentation illustrates the role of pregabalin in successful medical management of this chronic pain disorder, as well as the management of common psychiatric morbidities associated with this condition.

Topics: Amitriptyline; Analgesics; Anti-Ulcer Agents; Anticoagulants; Antidepressive Agents; Anxiety; Cardiotonic Agents; Cataract; Cataract Extraction; Cholecystectomy; Chronic Disease; Citalopram; Digoxin; Female; gamma-Aminobutyric Acid; Heart Failure; Humans; Hypertension; Hysterectomy; Lorazepam; Middle Aged; Mitral Valve Insufficiency; Omeprazole; Ovarian Neoplasms; Pain; Pregabalin; Sterilization, Tubal; Stomach Diseases; Vulvar Diseases

Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation.. Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) < or = 30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF < or = 30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF < or = 30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (P=0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class.. Patients with CHF having a flexible ring have a higher likelihood of developing recurrent MR requiring reoperation. The use of a nonflexible ring appears to significantly reduce the need for repeat surgical procedures. Further refinement and development of nonflexible ring systems, aimed at LV restoration, deserve ongoing investigation.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiomyopathy, Dilated; Combined Modality Therapy; Databases, Factual; Digoxin; Diuretics; Drug Therapy, Combination; Equipment Design; Female; Follow-Up Studies; Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans; Male; Middle Aged; Milrinone; Mitral Valve; Mitral Valve Insufficiency; Norepinephrine; Pliability; Postoperative Complications; Prospective Studies; Recurrence; Reoperation; Spironolactone; Stroke Volume; Time Factors; Tricuspid Valve Insufficiency; Ultrasonography

A 34-year-old previously healthy woman was admitted to another hospital because of abdominal pain, cough and dyspnea. Peripheral eosinophilia was present. Two months later she was admitted to the cardiology department with signs of mitral regurgitation. Dyspnea, fatigue, skin rashes with pruritus and a systolic murmur were noted.. Laboratory tests showed 11.4/nl leukocytes (normal range 4.8-10.8/nl) with an eosinophilia of 19% (normal range < 4%) corresponding to 2.2/nl. Cardiac magnetic resonance imaging revealed endomyocardial fibrosis involving the posterior mitral leaflet with resulting valvular regurgitation. Doppler ultrasound showed restrictive heart failure. DIAGNOSIS, THERAPY AND FURTHER COURSE: The diagnosis of idiopathic hypereosinophilia most likely as part of hypereosinophilic syndrome with cardiac involvement was made. The patient was treated with digitalis, diuretics and peptidyl dipeptidase (PDP) inhibitor. The treatment with glucocorticoids and cytotoxic agent to achieve a reduction of eosinophil count was ended by the patient a few weeks later.. The hypereosinophilic syndrome with endomyocardial fibrosis is rare, and its prognosis is grave. The pathophysiological mechanisms are not entirely clear, nearly 70 years after Löffler first described fibrous endocarditis with eosinophilia. Patients receive symptomatic medical therapies. Additional surgical treatment has been reported,. Antihypereosinophilic therapy is used to control the disease.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiomyopathy, Restrictive; Cardiotonic Agents; Diagnosis, Differential; Digoxin; Diuretics; Drug Therapy, Combination; Echocardiography, Doppler; Enalapril; Endomyocardial Fibrosis; Female; Humans; Hypereosinophilic Syndrome; Magnetic Resonance Imaging; Mineralocorticoid Receptor Antagonists; Mitral Valve Insufficiency; Patient Compliance; Prognosis; Spironolactone; Sulfonamides; Torsemide

Rheumatic mitral regurgitation (MR) causes heart failure by volume overload and an increase in atrial natriuretic peptide (ANP) levels by atrial stretching. Symptoms of heart failure improve with ANP treatment. Angiotensin-converting enzyme inhibitors (ACEI) and ANP have similar effects, such as vasodilation, natriuresis and diuresis.. To determine ANP levels and response to ACEI treatment in children with rheumatic MR.. Patients with rheumatic MR were divided into two groups: the digoxin group (10 girls, two boys; age range 10 to 18 years, mean 14 +/- 0.72 years; taking digoxin for at least one year) and the control group (eight girls, four boys; age range eight to 17 years, mean 13.5 +/- 0.81 years). None of the patients in either group had symptoms of heart failure. Serum ANP levels, left ventricular systolic functions, and mitral and aortic stroke volumes of both groups were evaluated on admission. The digoxin group was given ACEI and re-evaluated on the 20th day of treatment.. At baseline, ANP levels were higher in the digoxin group (27.3 +/- 6.5 pg/100 microL) than in the control group (6.9 +/- 0.9 pg/100 microL) (P<0.05). On the 20th day of treatment, there were no significant differences in the ANP levels of the digoxin (13.2 +/- 6.1 pg/100 microL) and control groups. There was a significant decrease in ANP levels in the digoxin group between baseline and the 20th day of therapy. Mitral stroke volumes (510.4 +/- 92.8 mL/m2) and left ventricular diastolic volume (108 +/- 12 mL/m2) in the digoxin group at baseline were higher than those in the control group (315.3 +/- 59.9 mL/m2 and 82 +/- 6.5 mL/m2, respectively) on admission; on the 20th day of treatment, there were no significant differences in these values. At baseline, aortic stroke volume in the digoxin and control groups were 86.9 +/- 59.1 and 82.9 +/- 28.3 mL/m2, respectively (P>0.05). On the 20th day of therapy, the aortic stroke volume of digoxin group had increased to 104.7 +/- 70.1 mL/m2, significantly higher than that of the control group.. ANP levels are a good indicator of volume overload. ACEI should be introduced at an early stage of rheumatic MR because, even if patients are taking digoxin, their heart failure may progress silently.

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Atrial Natriuretic Factor; Case-Control Studies; Child; Digoxin; Echocardiography; Female; Humans; Male; Mitral Valve Insufficiency; Rheumatic Heart Disease; Stroke Volume; Treatment Outcome; Ventricular Function, Left

Described originally in 1882, Gaucher's disease is the most prevalent of storage disorders. This autosomal recessive disease is caused by a defective gene responsible for coding the beta-glucosidase enzyme, essential in the hydrolysis of glucosylceramide in glucose and ceramide. The accumulation of glucosylceramide in the lysosomes of the reticuloendothelial system produces a heterogeneous clinical picture with neurological involvement, liver and spleen enlargement, hematological disorders and bone lesions.. Two pregnancies of a patient with Gaucher's disease are presented. The patient, who had been asymptomatic following earlier splenectomy, developed congestive heart failure due to myocardial involvement at the beginning of her first pregnancy, and responded to conservative treatment. In spite of this complication and also chronic anemia, hepatomegaly and ascites due to portal hypertension, the patient had two successful pregnancies with good perinatal results. No hemorrhagic complications were observed.

Topics: Adult; Cardiomyopathy, Dilated; Cardiotonic Agents; Digoxin; Diuretics; Female; Gaucher Disease; Heart Ventricles; Humans; Mitral Valve Insufficiency; Pregnancy; Pregnancy Complications, Cardiovascular; Ultrasonography

Fifteen and eight mature beagles, without (normal group) and with experimental mitral regurgitation (MR group), respectively, were given 0.02 mg/kg/day digoxin powder for 10 days orally. The optimum time for sample collection after administration of digoxin was observed to be 8-18 hr and 10-22 hr in the normal and MR groups, respectively. In both groups, a stable concentration was reached after 3-5 days of treatment. No differences in plasma level were observed between sexes. The optimum concentration of digoxin was attained at an earlier stage than has been previously reported for both dogs and humans.

Topics: Animals; Anti-Arrhythmia Agents; Digoxin; Dog Diseases; Dogs; Female; Half-Life; Male; Mitral Valve Insufficiency; Sex Factors; Time Factors

We report the case of a two-year-old girl with end-stage dilated cardiomyopathy who was a status I heart transplant candidate. Partial left ventriculectomy and novel mitral valve repair were performed. Early hemodynamic and functional improvements were maintained at the 18-month follow-up.

Topics: Antihypertensive Agents; Captopril; Cardiomyopathy, Dilated; Cardiotonic Agents; Child, Preschool; Digoxin; Diuretics; Dobutamine; Female; Follow-Up Studies; Furosemide; Heart Failure; Heart Transplantation; Heart Ventricles; Hemodynamics; Humans; Mitral Valve; Mitral Valve Insufficiency; Papillary Muscles

Each of 5 drugs, i.e., 4 different vasodilator drugs (captopril, enalapril, hydralazine and prazosin) and a cardiotonic drug (digoxin), was administered to dogs with mitral regurgitation (MR) for 1-72 days in order to quantitatively evaluate the influence of therapeutic agents on blood flow in heart disease. Hemodynamic changes were assessed before and after administration of each drug by determining mitral regurgitant jet mapping area (MRMA) and aortic forward flow mapping area (AFMA), which were displayed by the color Doppler method, and the ratio of MRMA to AFMA (MRMA/AFMA) as parameters. When the four vasodilator drugs were used appropriately, MRMA and MRMA/AFMA decreased in all cases, compared with the values before the administration. These two parameters showed dose-dependent changes after administration of captopril, enalapril and hydralazine. When the cardiotonic drug was used. MRMA and MRMA/AFMA increased in 4 of 5 cases. The MRMA/AFMA values were slightly more reproducible than the MRMA values, whereas the AFMA values showed no constant tendency when any vasodilator drug or the cardiotonic drug was used. These results suggest that the efficacy of cardiotonic and vasodilator drugs in MR can be quantitatively evaluated by determining MRMA/AFMA in particular, and MRMA.

Topics: Animals; Captopril; Cardiotonic Agents; Digoxin; Dog Diseases; Dogs; Echocardiography, Doppler, Color; Enalapril; Hemodynamics; Hydralazine; Mitral Valve Insufficiency; Prazosin; Vasodilator Agents

The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.

Topics: Aortic Valve; Aortic Valve Insufficiency; Cardiotonic Agents; Digoxin; Diuretics; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Electrocardiography; Embolism; Endocarditis, Bacterial; Female; Follow-Up Studies; Furosemide; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Infarction; Penicillin G; Penicillins; Streptococcal Infections; Time Factors

Cardiopulmonary bypass (CPB) can induce several haemodynamic alterations and therefore influence pharmacokinetics of various drugs. In order to assess the effect of CPB on plasma digoxin levels, these were monitored in patients undergoing open heart surgery involving CPB (n = 11), over a 24 hour period, starting just prior to commencement of surgery. For comparison, plasma digoxin was also monitored in a group of patients (n = 10) who underwent cardiac surgery not involving CPB. In 7 of the 11 patients in the CPB group, plasma digoxin levels (ng/ml) were significantly (p < 0.01) lower at the end of 24 hours (0.654 +/- 0.094) than basal levels (1.3114 +/- 0.2498). In contrast, in the non CPB group, 7 of 10 patients showed significantly higher (p < 0.001) plasma levels (ng/ml) at the end of 24 hours (0.477 +/- 0.125) as compared to basal levels (0.26 +/- 0.098). Thus, rather than the type of surgery, it appears that the pre-operative levels of plasma digoxin influence its pharmacokinetics.

Topics: Adult; Cardiopulmonary Bypass; Cardiotonic Agents; Case-Control Studies; Digoxin; Female; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Rheumatic Heart Disease; Time Factors

Overall 75 patients with rheumatic mitral heart disease were examined for the effect of the clinical and echocardiography characteristics of central and intracardiac hemodynamics on the efficacy of the use of digoxin. The development of digoxin resistance in patients with the predominance of stenosis of the mitral opening depended to the greatest degree on the duration of heart decompensation, area of the mitral opening and duration of the phase of left ventricle relaxation; in patients with the predominance of mitral insufficiency, it depended on the level of endosystolic stress, pressure of left ventricle filling and duration of the phase of isometric left ventricle contraction. Based on the calculation of the information content of the parameters under study, a prognostic table was made. The use of the table allowed forecasting the development of glycoside resistance in 77.6% of cases.

Topics: Adult; Cardiac Glycosides; Digoxin; Drug Resistance; Echocardiography; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Prognosis; Rheumatic Heart Disease

A study was undertaken to examine 55 (27 females and 28 males) patients aged 25 to 74 years who had ventricular arrhythmias. Twenty five patients were diagnosed as having mitral valvular disease concurrent with predominant stenosis, 30 presented with prevalent mitral dysfunction. Twenty eight patients showed Stages I to IIA circulatory failure, and 27 had Stages IIB to III heart failure. All the patients displayed perpetual ciliary arrhythmia of various duration. More frequent and severe ventricular arrhythmias were recorded in mitral valvular disease patients with predominant mitral dysfunction than in those with stenoses. When the plasma digoxin concentration was less than 1.1 ng/ml in patients with a low end-diastolic volume and initial signs of circulatory failure, the agent produced an antiarrhythmic effects on ventricular arrhythmias in many cases, in mitral valvular disease patients with predominant stenosis in particular. The arrhythmogenic effect of digoxin was found in 47.6% patients with prevalent mitral dysfunction concurrent with Stages IIB-III circulatory failure. The agent may show arrhythmogenic action in mitral valvular disease patients with prevalent mitral dysfunction who had larger cardiac volumes and plasma digoxin concentrations of no more than 1.6 ng/ml in the absence of clinical signs of digitalis intoxication.

Topics: Adult; Aged; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis

This study was designed to determine whether digoxin therapy in the canine heart failing because of mitral regurgitation (MR) provides only hemodynamic benefit and accompanying subjective improvement or if it also reverses the changes in intracellular Ca++ and sarcolemmal Na+-K+-ATPase. The dogs were divided into four groups: control, MR of 3 months' duration, MR of 6 months', and digoxin treatment for 3 months after 3 months of MR. Six months of MR produced a marked decrease in the index of myocardial contractility and function associated with a decrease in intracellular Ca++ and Na+, and an increase in intracellular K+, extracellular space, sarcolemmal Na+-K+-ATPase, and Mg++-ATPase. Digoxin treatment tended to return the changes in the index of myocardial contractility and cardiac function, intracellular Ca++, Na+, K+, extracellular space, and sarcolemmal Na+-K+-ATPase of the failing heart toward control levels. Digoxin treatment did not affect Mg++-ATPase. The right ventricle, which did not fail, also did not show any significant changes in the parameters measured. The results showed that digoxin treatment not only improved the index of myocardial contractility and cardiac function of the failing heart but also tended to return the electrolytes and sarcolemmal Na+-K+-ATPase toward control levels.

Topics: Animals; Calcium; Digoxin; Dogs; Extracellular Space; Female; Heart; Heart Failure; Hemodynamics; Male; Mitral Valve Insufficiency; Myocardium; Potassium; Sarcolemma; Sodium; Sodium-Potassium-Exchanging ATPase

To determine the acute and chronic effects of vasodilator therapy in children, vasodilator therapy was evaluated in 13 children (aged 0.2 to 14.5 years) with severe left ventricular dysfunction or mitral regurgitation. In seven children, nitroprusside increased cardiac index by an average of 33% (P less than .01) and increased stroke index by 29% (P less than .01). In eight children, hydralazine caused a 31% increase in cardiac index (P less than .01) and a 27% increase in stroke index (P less than .02). Ten children received chronic oral vasodilator therapy and were followed for 5.7 +/- 1.4 (SEM) months. Early clinical improvement was observed in every child. Symptoms of heart failure diminished in all, and five children became entirely asymptomatic. A significant (P less than .05) improvement was noted in growth velocity, respiratory rate, heart size, and incidence of gallop rhythm after 1 month of therapy. The duration of the beneficial response to vasodilator therapy varied considerably, however, and significant improvement for the group was not found after 1 month. Four children had sustained clinical improvement for 6 months or longer, but the others experienced recurrent heart failure within 1 to 4 months.

Topics: Adolescent; Captopril; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Heart Failure; Heart Ventricles; Hemodynamics; Humans; Hydralazine; Infant; Mitral Valve Insufficiency; Prazosin; Time Factors; Vasodilator Agents

Topics: Aortic Valve; Aortic Valve Insufficiency; Combined Modality Therapy; Digoxin; Drug Therapy, Combination; Heart Failure; Heart Valve Prosthesis; Hemodynamics; Humans; Hydralazine; Mitral Valve; Mitral Valve Insufficiency; Nitroprusside; Vasodilator Agents

Topics: Aged; Blood Pressure; Cardiac Output; Digoxin; Drug Therapy, Combination; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Nifedipine; Pyridines; Stroke Volume; Vascular Resistance

Topics: Digoxin; Female; Fetal Heart; Humans; Maternal-Fetal Exchange; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Time Factors; Tissue Distribution

Systolic time interval (STI) measurements were made in 44 patients with coronary artery disease: 38 had regional left ventricular (LV) asynergy, and the remaining 6 had normal ventricular contraction patterns on left ventricular angiography. There was a significant correlation between both the preejection period (PEP) (r = 0.70) and the PEP/LVET (LV ejection time) ratio (r = 0.66), with the extent of regional ventricular dysfunction measured quantitatively on the left ventricular angiogram (P less than 0.001). A PEP/LVET ratio greater than 0.50 was associated with ventricular asynergy involving more than 40% of the LV circumference at end diastole. STI measurements also correlated with ejection fraction but not with ventricular end diastolic pressure nor with the number of obstructed coronary arteries.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Heart Ventricles; Hemodynamics; Humans; Middle Aged; Mitral Valve Insufficiency; Myocardial Contraction; Systole; Time Factors

Topics: Digoxin; Diuresis; Female; Humans; Mitral Valve Insufficiency; Postoperative Period; Potassium; Preoperative Care; Rheumatic Heart Disease; Sodium

Four dogs with congestive heart failure associated with dirofilariasis and mitral valvular incompetence initially responded to treatment with digoxin or etamiphylline camsylate, and frusemide but became refractory to this therapy and were in cardiac decompensation. Frusemide dosage was increased and the alpha adrenoreceptor blocking drug prazosin hydrochloride was added to the therapeutic regime. Six weeks later all dogs were stabilized and their clinical condition was markedly improved.

Topics: Animals; Digoxin; Dirofilariasis; Dog Diseases; Dogs; Female; Furosemide; Heart Failure; Male; Mitral Valve Insufficiency; Prazosin; Quinazolines

Topics: Cardiac Glycosides; Chronic Disease; Coronary Disease; Digoxin; Humans; Mitral Valve Insufficiency; Pulmonary Heart Disease; Rheumatic Heart Disease; Risk

A case of double mitral valve orifice associated with atrioventricular canal was found at operation. These two anomalies are frequently associated. Double mitral valve is usually subclinical and does not necessarily need to be corrected, depending on the associated anomalies, the extent of the defect, and the personal experience of the surgeon. The embryology of double mitral valve is complicated and still needs to be clarified.

Topics: Anemia, Hemolytic; Bilirubin; Child; Child, Preschool; Digoxin; Female; Heart Septal Defects; Humans; Mitral Valve; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency

Topics: Adolescent; Child; Digoxin; Humans; Mitral Valve Insufficiency; Oxygen Consumption; Rheumatic Heart Disease

A comparative analysis is presented of the Sonnenblick contractility index, end-diastolic and systolic pressure in the right ventricle, cardiac index in 76 patients with mitral-tricuspid disease and with a mitral disease alone. Higher figures of the contractility index of the right ventricle were obtained in patients with an organic tricuspid defect with a predominance of insufficiency, than in those with mitral insufficiency and relative tricuspid insufficiency. The contractility index of the right ventricle decreases along with an increasing stenosis of the right venous ostium. The study has demonstrated that the patients with mitral-tricuspid defects tend to display a less distinct inotropic reaction to Digoxin as compared with those having a mitral defect alone.

Topics: Adolescent; Adult; Digoxin; Heart Ventricles; Hemodynamics; Humans; Middle Aged; Mitral Valve Insufficiency; Myocardial Contraction; Stimulation, Chemical; Tricuspid Valve Insufficiency

The study was conducted in 80 patients with moderate compensatid mitral valve diseases without any signs of active rheumatic disease and preserved sinus rhythm. On the basis of a clinical examination two groups of patients were singled out: those without clinical manifestations of circulatory insufficiency, and those with Stage 1 circulatory insufficiency. In both groups of patients, at rest and following exercises, a reduced tolerance of physical exercises was observed, as well as a reduction of the minute and stroke indices. Better tolerance of exercises and improved haemodynamic parameters were noted in both groups following Digoxin therapy. The results of the study prompt the presence of a latent cardiac insufficiency in patients without clinical manifestations of the latter, and permit to recommend its therapy with cardiotonic doses of cardiac glycosides.

Topics: Adaptation, Physiological; Adult; Cardiac Output; Cardiac Volume; Digoxin; Female; Follow-Up Studies; Heart; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Physical Exertion

The successful simultaneous closure of a persistent ductus arteriosus and mitral valve replacement in a 65-year-old woman with pulmonary hypertension is reported. The approach through a left thoracotomy gave good exposure and momentary cessation of cardiopulmonary bypass made ligation of the calcified ductus possible. Although this seems to be a rare association, when mitral valve disease is significant the simultaneous closure of the duct and mitral valve surgery is the treatment of choice.

Topics: Aged; Blood Pressure; Cardiac Catheterization; Cardiopulmonary Bypass; Cineangiography; Digoxin; Ductus Arteriosus, Patent; Female; Heart Rate; Humans; Hypertension, Pulmonary; Ligation; Methods; Mitral Valve; Mitral Valve Insufficiency; Practolol

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Catheterization; Digoxin; Female; Furosemide; Germany, West; Heart Diseases; Heart Failure; Heart Septum; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Prognosis; Pulmonary Artery; Pulmonary Edema; Rupture, Spontaneous; Shock, Cardiogenic; Strophanthins

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: Adolescent; Digoxin; Female; Heart; Heart Ventricles; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis

Topics: Anticoagulants; Blood Pressure; Cardiac Catheterization; Cardiomegaly; Dietary Fats; Digoxin; Diuretics; Heart Septal Defects, Ventricular; Heart Septum; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Oxygen; Rupture; Venous Pressure

Topics: Antihypertensive Agents; Bloodletting; Bronchodilator Agents; Digitalis; Digoxin; Furosemide; Heart Failure; Heroin; Hospitalization; Humans; Intensive Care Units; Mitral Valve Insufficiency; Mitral Valve Stenosis; Morphine; Oxygen Inhalation Therapy; Phytotherapy; Plants, Medicinal; Plants, Toxic; Positive-Pressure Respiration; Posture; Pulmonary Edema; Respiration, Artificial; Tourniquets; Venous Pressure

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: Ajmaline; Arrhythmias, Cardiac; Digoxin; Electric Countershock; Female; Glucagon; Heart Failure; Humans; Lanatosides; Middle Aged; Mitral Valve Insufficiency; Phenytoin; Phytotherapy; Plants, Medicinal; Pulmonary Edema; Quinidine; Rauwolfia; Water-Electrolyte Balance

Topics: Aged; Aortic Valve Insufficiency; Digitoxin; Digoxin; Ethacrynic Acid; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Oxygen Inhalation Therapy; Pulmonary Heart Disease; Spironolactone

Topics: Administration, Oral; Animals; Cardiac Catheterization; Cardiac Output; Cardiomyopathies; Chagas Disease; Coronary Disease; Digitalis Glycosides; Digoxin; Dogs; Electrocardiography; Heart Diseases; Hemodynamics; Humans; Hypertension; Male; Mitral Valve Insufficiency; Ouabain; Oxygen Consumption; Phonocardiography

Topics: Adolescent; Angiocardiography; Aortic Valve Insufficiency; Cardiac Catheterization; Cineangiography; Digoxin; Diuretics; Humans; Male; Mitral Valve Insufficiency; Prednisone; Rheumatic Heart Disease

Topics: Cardiomyopathies; Child; Child, Preschool; Coronary Disease; Diagnosis, Differential; Digoxin; Humans; Hypertension; Infarction; Mitral Valve Insufficiency; Pericarditis, Constrictive; Prognosis

Topics: Blood Pressure; Cardiac Catheterization; Digoxin; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pulmonary Heart Disease; Strophanthins; Theobromine; Veins

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