digoxin and Puerperal-Disorders

This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti.. Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013. Evaluation included history and physical, CBC, renal/metabolic profile, serum glucose, anti-HIV antibody, ECG, chest radiograph and echocardiogram. Treatment included angiotensin converting enzyme inhibitors, furosemide and spironolactone, carvedilol, digoxin and anticoagulation.. Women (62.4%) outnumbered men; patients were relatively young (mean age 50.1) and from the lowest socio-economic levels of the population. Nearly all (98.8%) presented with NYHA III-IV status, with correspondingly high mortality (23.3%). Echocardiography showed 73% dilated cardiomyopathy; 83% showed moderate to severe LV systolic dysfunction (mean EF 36.5 +/- 15%) and 17% preserved LV systolic function. The three principal etiologies were dilated cardiomyopathy (29%) hypertensive cardiomyopathy (27%) and peripartum cardiomyopathy (20%). Ischemic cardiomyopathy was rare (3.4%). At 27 months follow-up, 76.7% of the patients were alive and well. Among those who died, mean survival time was 113 days. Readmission carried a poor prognosis.. This congestive heart failure study from Haiti shows an unusually high proportion of young women, primarily due to peripartum cardiomyopathy. Ischemic cardiomyopathy is rare, as in Africa. Further study is warranted to address the particular problem of the high frequency of peripartum cardiomyopathy in this population.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Age Distribution; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Carbazoles; Cardiomyopathy, Dilated; Cardiotonic Agents; Carvedilol; Cohort Studies; Digoxin; Diuretics; Echocardiography; Electrocardiography; Female; Furosemide; Haiti; Heart Failure; Hospitalization; Hospitals, University; Hospitals, Urban; Humans; Hypertension; Male; Middle Aged; Pregnancy; Pregnancy Complications, Cardiovascular; Propanolamines; Prospective Studies; Puerperal Disorders; Sex Distribution; Spironolactone; Stroke Volume; Young Adult

Peripartum cardiomyopathy is rare in developped countries, but still frequent in Africa. It is defined as a heart failure occurring during peripartum, without any underlying etiology. Authors present 3 cases showing that heart failure before or after delivery may be due to causes which are frequent in the Sahelian area but generally misdiagnosed. Anemia, hypertension and rheumatic fever were the causes of heart failure in these 3 patients, but they were not apparent when the initial diagnosis was made. These observations emphasize that, despite the complex hypothesis trying to explain heart failure during the peripartum period, one should think about some frequent causes which can be misdiagnosed because of the pregnant state or the heart failure itself.

Topics: Adult; Africa, Northern; Anemia; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cardiotonic Agents; Causality; Developing Countries; Digoxin; Diuretics; Echocardiography; Female; Furosemide; Heart Failure; Humans; Hypertension; Incidence; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Rheumatic Fever; Sudan

A thirty-six year old woman who had an acute myocardial infarction during the early postpartum period is described. Review of literature on the incidence of postpartum myocardial infarction, the possible mechanisms and its clinical implications are summarized.

Topics: Adult; Aspirin; Digoxin; Electrocardiography; Ergonovine; Female; Heart Aneurysm; Humans; Isosorbide Dinitrate; Myocardial Infarction; Nifedipine; Pregnancy; Puerperal Disorders

The pharmacokinetics of digoxin were investigated in 8 pregnant women (2-3 months before delivery), in three women 3 months after delivery, and in 3 non-pregnant women, after i.v. injection of 500 microgram. Digoxin was evaluated in serum with the radioimmunoassay method. In pregnant women C1 (concentration of digoxin in the first compartment) and V1 (volume of the first compartment) were higher and C2, K1-2, K2-1 (exchange constants) and Kel (elimination constant) were all lower than the values obtained in both post-partum and non-pregnant women. Our data lead us to think that the exchange (both uptake and release) between the first and second compartment is lowered in pregnancy.

Topics: Adult; Cardiovascular Diseases; Digoxin; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Radioimmunoassay

Full recovery occurred after 15 months of severe congestive heart failure in a patient with peripartum cardiomyopathy. Clinical improvement was noted when propranolol was added to conventional therapy.

Topics: Digoxin; Diuretics; Female; Heart Failure; Humans; Pregnancy; Propranolol; Puerperal Disorders; Time Factors

Topics: Adult; Angiocardiography; Black People; Cardiomyopathies; Digoxin; Diuretics; Electrocardiography; Female; Heart Failure; Hemoglobinometry; Humans; Hypertension; Middle Aged; Nigeria; Parity; Phonocardiography; Pregnancy; Puerperal Disorders

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