digoxin and Myocarditis

Myocarditis is a poorly understood condition and its prevalence is largely underestimated. A significant proportion of cases may be subclinical and chronic, leading to dilated cardiomyopathy, which represents the first cause of heart transplantation worldwide. Although inflammation of the myocardium can be associated with various causes, particularly viruses, myocarditis is usually idiopathic. Present evidence suggests that some 'idiopathic' and chronic 'postviral' myocarditis cases may be autoimmune, whereas others with acute self-limited disease or with persisting pathogenic virus by molecular methods may represent viral myocarditis. The major obstacle in identifying a specific therapy in myocarditis lies in the difficulty of a thorough clinical characterisation of individual patients in relation to viral and autoimmune involvement. This also explains the inconclusive results of trials of immunosuppressive drugs in myocarditis/dilated cardiomyopathy. Diagnosis is based upon endomyocardial biopsy. Management of myocarditis requires avoidance of agents that exacerbate myocarditis or depress myocardial function, and conventional therapy for heart failure (diuretics, ACE inhibitors and, if indicated, digoxin) and arrhythmias. Although at present the use of immunosuppressive therapy cannot be recommended on a routine basis, the recent Myocarditis Treatment Trial, where an aetiologically heterogeneous patient population was treated without significant adverse effects, provides some rationale for applying the same immunosuppression protocol to selected patients, e.g. those with active biopsy-proven myocarditis, unresponsive to conventional therapy, prior to transplantation, and those with idiopathic giant cell myocarditis.

Topics: Aging; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Autoimmune Diseases; Biopsy; Digoxin; Diuretics; Humans; Immunosuppressive Agents; Myocarditis; Virus Diseases

Monoclonal antibody technology has resulted in an entirely new class of agents, which have been applied to a variety of problems in cardiology and which hold great promise for future diagnostic, as well as therapeutic, applications. The four antibodies, which have been most widely used in clinical cardiology, are Digibind, OKT3, Myoscint, and 7E3. Each demonstrates the unique potential for the use of antibodies in clinical cardiology.

Topics: Antibodies; Antibodies, Monoclonal; Blood Platelets; Digoxin; Graft Rejection; Heart Diseases; Heart Transplantation; Humans; Muromonab-CD3; Myocardial Infarction; Myocarditis; Myosins; Radionuclide Imaging; Receptors, Antigen, T-Cell

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cardiotonic Agents; Child, Preschool; Digoxin; Female; Fever; Heart Failure; Humans; Myocarditis; Rheumatic Fever

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiotonic Agents; Digoxin; Heart Failure; Humans; Myocarditis; Platelet Aggregation Inhibitors; Ventricular Dysfunction, Left

Results of recent studies suggest that proinflammatory cytokines cause myocardial contractile dysfunction, and that the drugs used to treat heart failure modulate the production of cytokines. This study was designed to examine the effects of digoxin in a murine model of heart failure induced by viral myocarditis. Four-week-old inbred DBA/2 mice were inoculated intraperitoneally with encephalomyocarditis virus (EMCV). Digoxin was given orally in doses of 0.1, 1 or 10 mg/kg daily from the day of virus inoculation. Interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF)-alpha production in the heart were measured on day 5 after EMCV inoculation by enzyme-linked immunosorbent assay. The 14-day mortality tended to be increased in mice treated with 1 mg/kg, and was significantly increased in the group treated with 10 mg/kg per day. Myocardial necrosis and cellular infiltration on day 6 were significantly more severe in the high-dose digoxin group than in the control group. In the animals treated with 1 mg/kg digoxin, IL-1beta was significantly higher than in the control group. Intracardiac TNF-alpha levels were increased in a dose-dependent manner. These results suggest that digoxin worsens viral myocarditis, and that its use in high doses should be avoided in patients suffering from heart failure due to viral myocarditis.

Topics: Animals; Cardiovirus Infections; Digoxin; Encephalomyocarditis virus; Interleukin-1; Interleukin-6; Male; Mice; Mice, Inbred DBA; Myocarditis; Myocardium; Tumor Necrosis Factor-alpha

Pulmonary affections in patients with legionellosis are the main ones. The affections of the heart, gastrointestinal tract and other organs and systems are less frequent. Some characteristic features of the legionellosis clinical process in the case described are indicated. The torpid process of chronic bronchitis, the two-phase pattern of the disease, dyspnea at 3-4 month intervals, intermissions, edema and failure of complex therapy with antibiotics and cardiac glycosides provided a tentative diagnosis of Legionella pneumonia with affection of the myocardium. The importance of early serological diagnosis (enzyme immunoassay) was shown. A new approach to the treatment of legionellosis with cefuroxime was of interest.

Topics: Atrial Fibrillation; Cefuroxime; Cephalosporins; Digoxin; Drug Therapy, Combination; Female; Humans; Legionnaires' Disease; Middle Aged; Myocarditis; Pneumonia, Pneumococcal

Hydrops fetalis was diagnosed at 22 weeks. An ultrasound examination demonstrated cardiomegaly and a fetal blood specimen obtained by cordocentesis revealed thrombocytopenia, anaemia, and neutropenia. Fetal paracentesis yielded straw-coloured fluid with electrolytes indicative of a transudate. Non-enveloped icosahedral viral particles approximately 23 mm in diameter were visualized in the ascitic fluid by electron microscopy. Immune electron microscopy confirmed human parvovirus B19. Direct fetal digitalization led to a reduction in umbilical artery resistance, a decline in the abdominal circumference from 20.3 to 17.8 cm, and resolution of the ascites within 72 h. Despite this dramatic response to therapy, fetal death occurred on day 5 of treatment. The initial maternal serum was positive for anti-B19 IgM and IgG antibodies. Electron microscopy of fetal cardiac tissue obtained post-mortem revealed intranuclear viral particles typical of B19, confirming the antenatal diagnosis of myocarditis. This case demonstrates that direct viral identification is applicable to prenatal diagnosis. To our knowledge, this is the first reported case of the antenatal diagnosis and palliative treatment of fetal viral infection.

Topics: Adult; Digoxin; Female; Humans; Hydrops Fetalis; Myocarditis; Palliative Care; Parvoviridae Infections; Pregnancy; Prenatal Diagnosis; Ultrasonography

In rats with adrenaline-induced myocarditis conditionally therapeutic doses of strophanthin (2.7 mg/kg) and digoxin (0.89 mg/kg) were chosen according to performance of the test of swimming until the complete fatigue. The influence of drugs in these doses on enzymatic activity was evaluated by histochemical methods in heart of control and myocarditis rats. It was found out that both of cardiac glycosides decreased lactate dehydrogenase and membrane Na+, K+-ATPase activity and increased succinate dehydrogenase activity in rats with experimental myocarditis.

Topics: Animals; Digoxin; Drug Evaluation, Preclinical; Epinephrine; Heart; L-Lactate Dehydrogenase; Male; Myocarditis; Myocardium; Physical Exertion; Rats; Sodium-Potassium-Exchanging ATPase; Strophanthins; Succinate Dehydrogenase

Topics: Arthritis, Juvenile; Child, Preschool; Digoxin; Female; Humans; Infant; Male; Myocarditis

A 9-year-old male with myocarditis is described. A greater than four-fold rise in titers against rubella with a subsequent fall supports the conclusion that his myocarditis was associated with rubella infection. Other than neonates, rubella myocarditis has been reported previously in only six patients, one of whom was a child.

Topics: Adrenal Cortex Hormones; Cardiomegaly; Child; Digoxin; Humans; Male; Myocarditis; Penicillins; Rubella

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

Topics: Abdomen, Acute; Aerosols; Child, Preschool; Chloral Hydrate; Cold Temperature; Coma; Croup; Diazepam; Digoxin; Dyspnea; Emergencies; Epiglottis; Epinephrine; Humans; Infant; Infant, Newborn; Laryngismus; Myocarditis; Plasma Substitutes; Posture; Prednisolone; Prednisone; Shock, Septic

Topics: Digoxin; Drug Therapy, Combination; Furosemide; Humans; Myocarditis; Prednisolone; Strophanthins

After intravenous application of 1 mg digoxin in a 28-year-old patient with condition after myocarditis by means of premature atrial individual stimulation a SA-block I. type II was observed. Also in extremely premature stimuli the post-extrasystolic pauses remained compensating. After atrial double and multiple stimulation--a new method for the calculation of the sinuatrial conduction time--totally irregular poststimulation pauses appeared, which were regarded as an expression of a sinoauricular node initial block. Other possibilities of explanation are discussed.

Topics: Adult; Cardiac Pacing, Artificial; Digoxin; Heart Block; Humans; Male; Myocarditis; Sinoatrial Block; Sinoatrial Node; Time Factors

Topics: Adolescent; Adrenal Cortex; Adult; Cardiomegaly; Catecholamines; Digoxin; Female; Humans; Male; Middle Aged; Myocarditis; Propranolol; Sympathetic Nervous System

Three children are described who have had myocarditis as part of juvenile rheumatoid arthritis (JRA). The diagnosis was established by the appearance of cardiomegaly or congestive heart failure or both in the absence of substantial pericardial effusion or extra cardiac cause. Myocarditis, in these cases, occurred on a background of severe, active systemic disease. No pathologic specimens from hearts of acute cases are available, but an autopsy specimen of one child who died after two months of treatment with high doses of steroids showed diffuse changes typical of the "dilated ventricle" type of cardiomyopathy. Treatment with high doses of adrenocorticosteroids has been rapidly successful in controlling the acute phase, while digoxin must be used with extreme care because of high incidence of toxicity to glycosides.

Topics: Adolescent; Arthritis, Juvenile; Child; Dexamethasone; Digoxin; Echocardiography; Electrocardiography; Female; Gold; Humans; Hydrocortisone; Male; Myocarditis; Prednisone

Topics: Acute Disease; Child; Child, Preschool; Chronic Disease; Coronary Disease; Digoxin; Humans; Infant; Infant, Newborn; Myocarditis; Pneumonia; Strophanthins

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Topics: Cardiomyopathies; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction; Myocarditis

In 20 children needing treatment for symptomatic sick sinus syndrome, the average age at presentation was 7.1 years and ranged from 9 months to 18 years. Symptoms were never precise but, in retrospect, 5 children had syncope, 7 had a rapid heart action, 6 had dyspnoea or tachypnoea, 2 had nonspecific chest pains, 2 had pale spells, and 1 had a sudden hemiplegia. Symptoms followed cardiac surgery in 15 cases and were related to unoperated congenital heart disease in 2 and to myocarditis in 2. The aetiology was unknown in 1 case. The type of cardiac surgery resulting in the development of the sick sinus syndrome was predominantly related to atrial suturing. Both tachy- and bradydysrhythmias were found, including wandering atrial pacemaker (9 cases), junctional rhythm (19 cases), supraventricular tachycardia (9 cases), atrial flutter (11 cases), and atrial fibrillation (2 cases). Both atrial (8 cases) and ventricular (7 cases) premature beats were seen. All patients were given trials of drug therapy but difficulties were encountered. Cardioversion was used for tachyarrhythmias in 11 cases without serious problems. Six children had permanent cardiac pacemakers inserted with good results. Recognition of the sick sinus syndrome in childhood is important and treatment must be regulated by the severity of symptoms.

Topics: Adolescent; Arrhythmia, Sinus; Arrhythmias, Cardiac; Bradycardia; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Dyspnea; Female; Heart Block; Heart Defects, Congenital; Heart Rate; Hemiplegia; Humans; Infant; Male; Myocarditis; Pacemaker, Artificial; Pallor; Syncope

Topics: Adult; Body Temperature; Cardiomegaly; Digoxin; Electrocardiography; Furosemide; Humans; Hydrocortisone; Male; Myocarditis; Pericarditis; Prednisone; Pulmonary Edema; Smallpox Vaccine

Topics: Administration, Oral; Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Drug Evaluation; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Myocarditis; Pregnancy

Topics: Cardiomyopathies; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Follow-Up Studies; Humans; Infant; Male; Myocarditis; Procainamide; Prognosis; Propranolol; Quinidine; Recurrence; Tachycardia, Paroxysmal; Time Factors; Ventricular Fibrillation

Topics: Anemia; Anti-Bacterial Agents; Cardiomyopathies; Diet, Sodium-Restricted; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Myocarditis; Palliative Care; Respiratory Tract Infections; Rest; Tachycardia, Paroxysmal

Topics: Adolescent; Age Factors; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant, Newborn; Infections; Male; Methods; Myocarditis; Quinidine; Sulfates; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Adult; Atrial Fibrillation; Digoxin; Heart Atria; Heart Block; Humans; Male; Myocarditis; Pacemaker, Artificial; Physical Exertion; Propranolol; Radio Waves; Remission, Spontaneous; Tachycardia; Tachycardia, Paroxysmal

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Angiocardiography; Cardiomegaly; Child; Coronary Vessel Anomalies; Diagnosis, Differential; Digitalis; Digoxin; Drug Therapy; Electrocardiography; Endocardial Fibroelastosis; Glycogen Storage Disease; Humans; Infant; Mumps; Myocarditis; Skin Tests