digoxin and Mitral-Valve-Stenosis

Topics: Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digitalis; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Block; Heart Failure; Humans; Isoproterenol; Lanatosides; Mitral Valve Stenosis; Pacemaker, Artificial; Tachycardia; Thoracic Surgery; Toxicology; Ventricular Fibrillation

The effect and choice of a drug to control heart rate for symptomatic improvement in patients with isolated mitral stenosis with normal sinus rhythm (n = 10) or atrial fibrillation (n = 10) were studied. Digoxin (0.25-0.5 mg daily), metoprolol (50-100 mg twice a day) and verapamil (40-80 mg three times a day) were evaluated for this purpose. An open randomised cross-over design was followed. The efficacy of a drug was evaluated by: (1) subjective improvement on a visual analog scale, and (2) objective improvement on repeated multi-stage symptom-limited treadmill exercise. In patients with sinus rhythm greater than or equal to 50% subjective improvement was seen in 90%, 40% and nil with metoprolol, verapamil and digoxin, respectively. The total work done by these patients was 1008 +/- 541 kpm (control), 2869 +/- 1418 kpm on metoprolol, 2369 +/- 884 kpm on verapamil and 1654 +/- 918 kpm on digoxin. In patients with atrial fibrillation greater than or equal to 50% subjective improvement was seen in 80%, 40% and 30% with verapamil, metoprolol and digoxin, respectively. The total work done by these patients was 555 +/- 232 kpm (control), 1379 +/- 553 kpm on verapamil, 1251 +/- 575 kpm on metoprolol and 716 +/- 340 kpm on digoxin. The degree of improvement on a drug appeared to be a function of its ability to control resting and exercise heart rates in two different rhythms in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Arrhythmia, Sinus; Atrial Fibrillation; Digoxin; Heart Rate; Humans; Metoprolol; Mitral Valve Stenosis; Random Allocation; Verapamil

Topics: Acute Disease; Clinical Trials as Topic; Coronary Disease; Digoxin; Drug Evaluation; Hemodynamics; Humans; Lanatosides; Mitral Valve Stenosis; Postoperative Period; Rheumatic Heart Disease; Strophanthins

Pregnancy increases stress on the circulation of parturient with mitral stenosis secondary to rheumatic heart disease and increases the risk of peripartum heart failure, especially during delivery. This study investigated the epidural anesthesia management for cesarean section in pregnant women with rheumatic heart disease and mitral stenosis.. 48 parturients with rheumatic heart disease and mitral stenosis that had cesarean section deliveries with epidural anesthesia in the Union Hospital, Fujian Medical University (Fuzhou, China) from Jan 2002 to Dec 2012 were retrospectively analyzed. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), central venous pressure (CVP), fluid intake volume and fluid output volume (blood loss + urine volume) were analyzed.. Medication included digitalis drugs for heart failure or potential heart failure, digoxin and furosemide for chronic congestive heart failure and beta blockers for arrhythmia. Frequent premature ventricular contractions were treated with lidocaine and propafenone. Dexamethasone was administered when heart failure occurred during less than 37 weeks gestation. HR, SAP, DAP, MAP and CVP were significantly increased at the time of delivery. The fluid intake volume was more elevated in the NYHA III-IV group of parturients than the NYHA I-II group, while fluid output volume was less. All parturients survived.. Epidural anesthesia was applied successfully for cesarean sections for parturients with rheumatic heart disease and mitral stenosis.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Anti-Arrhythmia Agents; Cesarean Section; China; Digoxin; Diuretics; Female; Furosemide; Gestational Age; Heart Failure; Humans; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnant Women; Retrospective Studies; Rheumatic Heart Disease; Young Adult

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

An 88-year-old woman was admitted to our hospital because of palpitations, dyspnea, orthopnea and appetite loss. On admission, small crackles were heard on her lower back, and her liver was swollen. Chest rentogenogram showed cardiomegaly (cardio-thoracic ratio 65.5%) and bilateral pleural effusion. Electrocardiograms showed atrial fibrillation with an average heart rate of 95 per minute. Echocardiography revealed mitral stenosis. Because the patient was considered to be suffered from heart failure due to mitral stenosis with atrial fibrillation, furosemide (20 mg per day) and digoxin (0.25 mg per day) was started. After digoxin had been raised to a dose of 0.50 mg per day because of sustained rapid ventricular response on the fourth hospital day, she complained of nausea and vomiting. Serum digoxin concentration was 2.55 ng/ml on the next day, and 1.08 ng/ml 96 hours after discontinuing digoxin. There was no complaint after digoxin was restarted with a dose of 0.05 mg per day. She complained of nausea again on the third day when the digoxin was raised to a dose of 0.083 mg in a blinded study. This observation indicates that digoxin intoxication could occur even in the smaller dose of digoxin than usual in the elderly.

Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Female; Furosemide; Humans; Mitral Valve Stenosis; Nausea; Vomiting

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

Digoxin was assayed in maternal and neonatal sera and in the amniotic fluid in 14 pregnant patients chronically digitalized for mitral stenosis. Neonatal serum levels of digoxin are linearly correlated with maternal concentrations of the drug, and all are inversely related to maternal creatinine clearance. Amniotic fluid levels of the drug are not related to serum levels, but relate to amniotic fluid creatinine concentration. Fetal serum levels are identical to maternal ones for all practical purposes, but bear no relation to amniotic digoxin concentration. Digoxin was assayed with a commercial kit showing very little cross-reactivity with endogenous digoxin-like cross-reacting compounds. Pitfalls in commercial digoxin assays and clinical implications are discussed.

Topics: Amniotic Fluid; Digoxin; Female; Fetal Blood; Humans; Infant, Newborn; Maternal-Fetal Exchange; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular

The hemodynamic effects of digoxin (0.01 mg/Kg) on congestive heart failure were compared in 32 patients with old myocardial infarction (OMI) (n = 9), dilated cardiomyopathy (DCM) (n = 10), acute myocardial infarction (AMI) (n = 5) and mitral stenosis (MS) (n = 8). The responses of heart rate (HR) and pulmonary capillary pressure (PCP) to digoxin in OMI, DCM and MS were marked but different in each of these groups and no significant changes were found in patients with AMI. The responses of cardiac index (CI) to digoxin in patients with OMI and DCM in whom left ventricular myocardial contractile force was impaired were divided into 2 groups (Group 1: CI increased more than 15% and Group 2: less than 15%). In Group 1, both CI and percent fractional shortening (%FS) before digoxin administration were lower than in Group 2, i.e., 1.97 +/- 0.27 vs 2.80 +/- 0.48 L/min/m2 (p less than 0.001) and 10.9 +/- 8.0 vs 19.5 +/- 11.9% (p less than 0.05), respectively. In MS, CI increased after digoxin administration only in the 2 patients with low CI and rapid HR in the control state. These results indicate that the mode of hemodynamic response to digoxin is considerably different in various diseases. They further suggest that digoxin should not be used in the early phase of AMI, although digoxin was of great clinical benefit in patients with OMI and DCM through such mechanisms as its positive inotropic and negative chronotropic effects and lowering of PCP.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Digoxin; Female; Heart Failure; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Contraction; Myocardial Infarction; Pulmonary Wedge Pressure

Topics: Adolescent; Adult; Aspirin; Child; Child, Preschool; Costs and Cost Analysis; Digoxin; Diuretics; Emergencies; Female; Humans; Male; Mitral Valve Stenosis; Myocarditis; Penicillin G Benzathine; Prednisone; Premedication; Pulmonary Edema; Rheumatic Heart Disease; Tropical Climate

Although most cases of sustained atrial fibrillation are associated with mitral valve disease, hypertension, cardiac failure and atherosclerotic heart disease, some cases occur in the absence of any identifiable organic pathology. The consequences of atrial fibrillation include reduction in cardiac output, systemic emboli and an exaggerated ventricular response to exercise. In most clinical situations, digoxin is the drug of choice for controlling the ventricular response. Cardioversion should be undertaken in appropriately selected patients.

Topics: Age Factors; Aged; Atrial Fibrillation; Cardiomegaly; Digoxin; Electric Countershock; Electrocardiography; Heart Failure; Humans; Hypertension; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Verapamil

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

Topics: Abortion, Therapeutic; Adult; Aminoglycosides; Digoxin; Eisenmenger Complex; Female; Furosemide; Heart Diseases; Humans; Mitral Valve Prolapse; Mitral Valve Stenosis; Penicillins; Pregnancy; Pregnancy Complications, Cardiovascular

Topics: Aged; Atrial Fibrillation; Digoxin; Echocardiography; Electrocardiography; Female; Fluoroscopy; Heart Ventricles; Humans; Mitral Valve Prolapse; Mitral Valve Stenosis; Radionuclide Imaging; Warfarin

The mechanism of atrial flutter is controversial. A 76-year-old woman with rheumatic heart disease was referred to our clinic with an unusual rhythm disturbance which initially appeared to be classic atrial flutter at a rate of 300 beats/min. Later tracings, however, demonstrated a rate exactly one-half that of the earlier ECGs, with an identical p-wave morphology and vector. This latter rhythm also behaved in a manner expected for a flutter mechanism in that both spontaneously and with carotid pressure high-degree atrioventricular block occurred without alteration of the underlying atrial mechanism. Finally, the two rates interchanged spontaneously over several days without any significant interval changes in medical therapy. These findings were initially explained as probable digoxin toxicity. The underlying mechanism, however, was more likely atrial flutter with exit block and in this patient may have represented another facet of her sick sinus syndrome. This unusual phenomenon is discussed in terms of previous reports and possible implications for the mechanism of atrial flutter.

Topics: Aged; Aortic Valve Insufficiency; Atrial Flutter; Digoxin; Female; Heart Block; Humans; Mitral Valve Stenosis

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

Topics: Acetyldigitoxins; Adult; Computers; Digitalis Glycosides; Digoxin; Humans; Lanatosides; Male; Mitral Valve Stenosis; Strophanthins

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

Topics: Aortic Valve Stenosis; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Cardiomyopathies; Coronary Disease; Digoxin; Electrocardiography; Heart; Heart Ventricles; Humans; Hypertension; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Pulmonary Heart Disease; Time Factors

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

Topics: 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: Arrhythmias, Cardiac; Digoxin; Electrocardiography; Heart Conduction System; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Stenosis; Propranolol; Wolff-Parkinson-White Syndrome

Topics: Adult; Digoxin; Female; Heart Failure; Humans; Lung; Male; Middle Aged; Mitral Valve Stenosis; Oxygen Consumption; Respiratory Function Tests

Topics: Atrial Fibrillation; Atropine; Digoxin; Electric Countershock; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Ouabain; Warfarin

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

Topics: Atrial Fibrillation; Cardiac Glycosides; Chromatography, Thin Layer; Digoxin; Humans; Male; Middle Aged; Mitral Valve Stenosis; Rheumatic Heart Disease; Tritium

Topics: Adult; Chlorpropamide; Digoxin; Female; Fetal Death; Furosemide; Gestational Age; Heart Valve Prosthesis; Humans; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Warfarin

Topics: Adult; Aged; Cardiomegaly; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Hypertrophy; Male; Middle Aged; Mitral Valve Stenosis; Rheumatic Heart Disease; Vectorcardiography

Topics: Adult; Africa, Central; Black or African American; Black People; Diagnosis, Differential; Digoxin; Endocarditis, Bacterial; Endomyocardial Fibrosis; Heart Failure; Humans; Mitral Valve Stenosis; Organomercury Compounds; Pulmonary Edema; Tropical Medicine

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

Topics: Cardiac Surgical Procedures; Digoxin; Drug Therapy; Electrocardiography; Embolism; Heart Diseases; Humans; Mitral Valve Stenosis; Penicillins; Radiography, Thoracic; Rheumatic Heart Disease; Thoracic Surgery; Thrombosis; Vectorcardiography

Topics: Blood Vessels; Cardiac Output; Coronary Vessels; Digitalis; Digoxin; Hemodynamics; Mitral Valve Stenosis