digoxin and Pulmonary-Edema

Fluid movement from the pulmonary capillaries into the interstitial space occurs continuously and is drained by the lymphatics. With increased leakage or decreased clearance, excessive extravascular lung water accumulates, initially as interstitial edema and subsequently as alveolar edema. The most common cause of pulmonary edema is an increase in microvascular hydrostatic pressure. An increased permeability of the capillaries is the other mechanism of production of pulmonary edema. An acute, critical reduction in colloid osmotic pressure may play a contributory role in pulmonary edema even at normal hydrostatic pressures. Dyspnea, diaphoresis, and anxiety characterize the clinical picture. A history of heart disease and congestive heart failure may be present in CPE, whereas evidence of an inciting event or disease process suggests NCPE. Hypoxia, decreased lung compliance, and increased shunt fraction are seen in both types of pulmonary edema, but the duration of pulmonary edema tends to be more severe and prolonged in NCPE. Evidence of increased permeability in NCPE distinguishes it from CPE. Clinically, this is assumed when pulmonary edema is demonstrated at normal PCWP and when edema fluid protein concentration and COP are close to those of plasma. The management of pulmonary edema consists of the improvement of gas exchange by methods that range from supplemental oxygen administration to mechanical ventilatory support with PEEP, depending on the severity of the disturbance in lung function. Improvement in myocardial function and a decrease in pulmonary congestion are accomplished with diuretics and morphine; in those patients who do not respond to this therapy, manipulation of preload, afterload, and myocardial contractility by vasodilators and inotropic agents may be required. In acute pulmonary edema, intravenously administered agents with a short half-life and rapid onset of action are preferred. The role of colloids in the treatment of pulmonary edema is controversial. The indications for the use of corticosteroids in ARDS are controversial, and an optimum dose has not been determined. Many clinicians tend to choose steroids to treat these patients, but the value of these agents in this setting awaits the results of controlled trials now under way.

Topics: Adrenal Cortex Hormones; Bloodletting; Capillary Permeability; Digoxin; Diuretics; Dobutamine; Dopamine; Emergencies; Heart Diseases; Humans; Hydrostatic Pressure; Lung; Morphine; Nitroglycerin; Nitroprusside; Osmotic Pressure; Plasmapheresis; Posture; Pulmonary Edema; Respiration, Artificial; Tourniquets; Vasodilator Agents

Topics: Acute Kidney Injury; Airway Obstruction; Anemia, Hemolytic; Arteriovenous Fistula; Asphyxia Neonatorum; Cardiac Output; Digoxin; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Hyperthyroidism; Hypoglycemia; Infant; Infant, Newborn; Isoproterenol; Medical History Taking; Pregnancy; Pulmonary Edema; Pulmonary Valve; Sepsis; Streptococcal Infections; Tachycardia, Paroxysmal; Tricuspid Valve Insufficiency

Topics: Acute Disease; Aminophylline; Assisted Circulation; Cardiac Glycosides; Digoxin; Diuretics; Electric Countershock; Heart; Heart Diseases; Heart Failure; Humans; Morphine; Ouabain; Oxygen Inhalation Therapy; Phentolamine; Pulmonary Edema; Tachycardia; Vasodilator Agents

Digoxin reduces hospitalizations due to heart failure (HF) and may also reduce mortality at low serum digoxin concentrations (SDC). Most HF patients are > or = 65 years, yet the effects of digoxin on outcomes in these patients have not been well studied.. Of the 7788 ambulatory chronic HF patients in normal sinus rhythm in the Digitalis Investigation Group trial (1991-1995), 5548 (2890 were > or = 65 years) were alive at 1 month and were either receiving placebo or had data on SDC. Of these patients, 982 had low (0.5-0.9 ng/mL) and 705 had high (> or = 1 ng/mL) SDC.. Among patients > or = 65 years, compared with 38% placebo patients, 34% low SDC patients died during 39 months of median follow-up (adjusted hazard ratio [AHR] = 0.81; 95% confidence interval [CI] = 0.68-0.96; p =.017). All-cause hospitalizations occurred in 70% of placebo and 68% of low-SDC patients (AHR = 0.86; 95% CI = 0.76-0.98; p =.019). Reduction in hospitalizations for HF occurred in both low and high SDC groups. High SDC was not independently associated with all-cause hospitalization or all-cause mortality. Age, impaired renal function, and pulmonary congestion reduced the odds of low SDC. Low-dose digoxin (< or = 0.125 mg/d) was the strongest independent predictor of low SDC (adjusted odd ratio = 2.37; 95% CI = 1.65-3.39); p <.0001).. Digoxin at low SDC was associated with a reduction in mortality and hospitalization in chronic geriatric HF, and low-dose digoxin was the strongest predictor of low SDC.

Topics: Age Factors; Aged; Canada; Cardiac Output, Low; Cardiotonic Agents; Chronic Disease; Creatinine; Digoxin; Diuretics; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Placebos; Pulmonary Edema; Renal Insufficiency; Survival Rate; Treatment Outcome; United States

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.

Topics: Adult; Aged; Atrial Fibrillation; Cardiomegaly; Clinical Trials as Topic; Digitalis; Digitoxin; Digoxin; Female; Heart Rate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Renal Dialysis; Tachycardia; Time Factors

Topics: Ankle; Bicarbonates; Blood Glucose; Blood Pressure; Calcium; Chemical Phenomena; Chemistry; Chlorides; Clinical Trials as Topic; Creatinine; Digoxin; Diuresis; Diuretics; Edema; Furosemide; Humans; Potassium; Pulmonary Edema; Sodium Isotopes; Sulfonamides; Urea; Uric Acid; Urination

Topics: Aged; Bradycardia; Clinical Trials as Topic; Digoxin; Female; Heart Diseases; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Pulmonary Edema; Pulmonary Heart Disease; Sclerosis

Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiotonic Agents; Catheterization, Swan-Ganz; Cesarean Section; Diagnosis, Differential; Digoxin; Diuretics; Dobutamine; Electrocardiography; Female; Furosemide; Heart Failure; Humans; Hydralazine; Intubation, Intratracheal; Nitroprusside; Pulmonary Edema; Twins; Vasodilator Agents

Peripatum cardiomyopathy is a rare disease, which appears as cardiac failure, at the end of pregnancy and puerperium without an apparent cause. The diagnosis is done clinically based in accepted criteria by Demakis, and it is confirmed by auxiliary tests. Treatment includes rest, digitalic and diuretic medications. Prognosis is bad when there is not symptomatic regression, with a high mortality soon after. The experience at Hospital Central Militar from 1967 to 1995, is presented. There were nine cases, two of which had died; and the presentation of the last case, is done herein.

Topics: Adult; Cardiomegaly; Cardiomyopathies; Cesarean Section; Digoxin; Elective Surgical Procedures; Female; Heart Failure; Hospitals, Military; Humans; Mexico; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Edema; Ultrasonography, Prenatal

An American Cocker Spaniel with low plasma taurine concentration (< 2 nmol/mL) was presented with dyspnoea associated with pulmonary oedema and a left ventricular shortening fraction of 9%. Emergency therapy with furosemide, dobutamine, nitroglycerine and oxygen supplementation led to a good response. Chronic therapy was started with enalapril, furosemide, digoxin and taurine. Improvement in all echocardiographic indices were noted over a 22 week follow-up, most notably an increase in left ventricular shortening fraction to 20%, a decrease of E-point septal separation from 14 mm to 7 mm and marked left ventricular remodelling. This degree of improvement in myocardial function may represent a direct link between dilated cardiomyopathy in the American Cocker Spaniel and plasma taurine deficiency. Alternatively, this response may reflect a breed-related cardiomyopathy with a natural history and therapeutic response not commonly seen in the more common large breed cardiomyopathy presentations.

Topics: Animals; Antihypertensive Agents; Breeding; Cardiomyopathy, Dilated; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Dog Diseases; Dogs; Dyspnea; Echocardiography; Enalapril; Female; Furosemide; Heart; Heart Ventricles; Nitroglycerin; Pulmonary Edema; Taurine; Vasodilator Agents

Topics: Animals; Creatinine; Digoxin; Dog Diseases; Dogs; Echocardiography; Electrocardiography; Heart; Heart Diseases; Heart Murmurs; Heart Rate; Lung; Male; Myocardium; Pulmonary Edema; Radiography; Syncope, Vasovagal; Urea

To evaluate the role of echocardiography in determining the cause of pulmonary edema in pregnancy and the impact this information has on management.. We studied prospectively 45 pregnant or recently postpartum women admitted to an obstetric intensive care unit with pulmonary edema during a 6-year period. Between 1 and 4 days after the onset of pulmonary edema, two-dimensional and M-mode echocardiography was performed, as was continuous, pulsed, and color Doppler echocardiography. The clinical diagnosis obtained from history, physical examination, chest radiograph, and laboratory data was compared with the echocardiographic diagnosis.. Three therapeutically and prognostically distinct groups were identified by echocardiography: 1) those with decreased systolic function (N = 19), 2) those with normal systolic function but increased left ventricular mass and presumed diastolic dysfunction (N = 17), and 3) those with normal hearts (N = 9). During the study period, two patients with systolic dysfunction died and one underwent cardiac transplantation. Patients with systolic dysfunction required short- and long-term treatment with digoxin, diuretics, and angiotensin-converting enzyme inhibitors. Those with diastolic dysfunction received diuretics and long-term antihypertensive therapy. Women with normal hearts required acute therapy only. In 21 patients (47%), echocardiography demonstrated clinically unsuspected findings, which altered the long-term management in 16.. Because clinical and roentgenographic findings do not accurately differentiate patients with respect to the presence and type of cardiac dysfunction, and because these subgroups differ with respect to treatment and probably prognosis, we recommend echocardiography to evaluate all pregnant women with pulmonary edema.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Digoxin; Diuretics; Echocardiography; Female; Humans; Hypertrophy, Left Ventricular; Oxygen Inhalation Therapy; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pulmonary Edema

Congestive heart failure in children is unusual as a presenting problem, and the nonspecific nature of the signs and symptoms in the pediatric population makes recognition difficult. Congenital heart disease is most common in the infant whereas older children most commonly develop congestive heart failure due to cardiomyopathy, myocarditis, electrolyte abnormalities, dysrhythmias, and, more rarely, endocarditis, and rheumatic carditis. Management focuses upon stabilization of the airway and ventilation while improving circulatory function. This is achieved by the use of inotropic agents, combined with attention to the volume and pressure overload, pulmonary problems, dysrhythmias, and ongoing follow-up.

Topics: Cardiotonic Agents; Digoxin; Diuretics; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Infant; Infant, Newborn; Pulmonary Edema; Respiration, Artificial

Topics: Adult; Digoxin; Echocardiography; Embolism, Amniotic Fluid; Female; Heart; Heart Ventricles; Humans; Pregnancy; Pulmonary Edema

Topics: Aminophylline; Cardiovascular Agents; Digoxin; Diuretics; Dobutamine; Dopamine; Heart Failure; Humans; Morphine; Nitroglycerin; Nitroprusside; Pulmonary Edema; Verapamil

Topics: Anaphylaxis; Anticoagulants; Brain Edema; Cerebrovascular Disorders; Dextrans; Digoxin; Hemodilution; Heparin; Humans; Intracranial Embolism and Thrombosis; Pulmonary Edema; Risk; Strophanthins

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: Diazepam; Digoxin; Diuretics; Dyspnea; Emergencies; Epinephrine; Glucocorticoids; Humans; Lidocaine; Myocardial Infarction; Nitrates; Pulmonary Edema; Theophylline

Topics: Aminophylline; Blood Pressure; Digoxin; Fever; Furosemide; Humans; Hydralazine; Male; Methyldopa; Middle Aged; Pulmonary Edema

A case of serious intoxication with CS tear gas (o-chlorobenzylidene-malononitrile) is reported in a previously healthy male subject of 43 years involving pulmonary edema complicated by pneumonia, signs of heart failure and evidence of hepatocellular damage. Comparison with animal and human exposures supports the etiologic and pathogenetic role of CS tear gas in the present case. The pulmonary edema may have been the consequence of unusual conditions of exposure and/or increased individual susceptibility. The question of the "safety" of CS tear gas is discussed.

Topics: Adult; Chemical and Drug Induced Liver Injury; Digoxin; Furosemide; Heart Failure; Humans; Male; Nitriles; o-Chlorobenzylidenemalonitrile; Pneumonia; Pulmonary Edema; Tear Gases

Topics: Cardiac Glycosides; Catecholamines; Digoxin; Diuretics; Dose-Response Relationship, Drug; Dyspnea; Heart Failure; Humans; Pulmonary Edema; Vasodilator Agents

On the patients with moderate and severe heart insufficiency haemodynamic, clinical and electrocardiographic examinations were carried out. After the application of digitoxin at the beginning in the majority of cases no favourable effects on clinical and haemodynamic findings could be proved. In 2 patients with cor pulmonale even a drastic deterioration with increase of the pulmonary pressure and formation of a pulmonary oedema developed. The temporary analysis of the systole and the estimation of the glycoside level did not give any reliable references. The recompensation began only after 2-3 days. In 5 out of 10 patients in whom the cardiac rhythm was continuously controlled by means of a tape storage device, after the application of digoxin ventricular extrasystoles appeared. Also in these cases increased as well as subtherapeutic digoxin-plasma levels were present. In 2 patients with hypertrophic obstructive cardiomyopathy the infundibular gradients were considerably increased by strophantin. The causes of the different reaction patters are to be sought in disease-specific peculiarities, in the degree of severity of the heart insufficiency, in the speed of the flooding of glycoside and several extracardiac factors.

Topics: Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Blood Pressure; Cardiac Complexes, Premature; Cardiomyopathy, Hypertrophic; Digitalis Glycosides; Digoxin; Female; Heart; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Edema; Pulmonary Heart Disease

During 1975, 38 of 44 infants with a birth weight of less than or equal to 1,500 gm who developed pulmonary edema and congestive heart failure due to a patent ductus arteriosus were managed medically until the ductus closed spontaneously days or weeks later. Overall survival was 71%, and there were no deaths among 11 infants weighing more than 1,250 gm. Pulmonary complications were prevalent and were attributed to the extensive use of mechanical ventilation required to control pulmonary edema. The results of this study document the results to be expected when small preterm infants with a symptomatic patent ductus arteriosus are managed without surgical or pharmacologic intervention and provide a basis for the rational design of clinical trials evaluating other management approaches.

Topics: Blood Transfusion; Digoxin; Ductus Arteriosus, Patent; Furosemide; Heart Failure; Hematocrit; Humans; Infant, Newborn; Infant, Premature; Pulmonary Edema

Topics: Aminophylline; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Heart Rate; Humans; Hypokalemia; Hyponatremia; Intermittent Positive-Pressure Breathing; Mineralocorticoid Receptor Antagonists; Oxygen; Potassium Deficiency; Pulmonary Edema; Tachycardia; Thyroid Diseases

Topics: Digoxin; Diuretics; Heart Failure; Humans; Male; Middle Aged; Oxygen Inhalation Therapy; Phentolamine; Pulmonary Edema; Shock, Cardiogenic

Pulmonary artery wedge and plasma colloid osmotic pressures and their relationship to pulmonary edema were investigated in 26 patients with acute myocardial infarction of whom 14 developed pulmonary edema. In the absence of pulmonary edema, both the pulmonary artery wedge pressure and plasma colloid osmotic pressure were in normal range; after onset pulmonary edema, a moderate increase in pulmonary wedge pressure and reduction in plasma colloid osmotic pressure were observed. When the gradient between the plasma colloid osmotic pressure and the pulmonary artery wedge pressure was calculated, highly significant differences were demonstrated (P less than 0.002). In the absence of pulmonary edema, this gradient averaged 9.7 (plus or minus 1.7 SEM) torr; following appearance of pulmonary edema, it was reduced to 1.2 (plus or minus 1.3) torr. During therapy with digoxin and furosemide, reversal of pulmonary edema was closely related to a concomitant change in the colloid osmotic-hydrostatic pressure gradient. These observations indicate that both increases in pulmonary capillary pressure and decreases in colloid osmotic pressure may follow the onset of pulmonary edema. Such decline in colloid osmotic pressure and especially the reduction in colloid osmotic-hydrostatic capillary pressure gradient may favor transudation of fluid into the lungs.

Topics: Adult; Aged; Blood Pressure; Cardiac Output; Digoxin; Female; Furosemide; Heart Rate; Humans; Hydrogen-Ion Concentration; Male; Microcirculation; Middle Aged; Myocardial Infarction; Osmotic Pressure; Oxygen; Pulmonary Circulation; Pulmonary Edema; Respiration; Shock, Cardiogenic; Water-Electrolyte Balance

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

Topics: Administration, Oral; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Heart Valve Diseases; Hemodynamics; Humans; Injections, Intramuscular; Injections, Intravenous; Myocardial Infarction; Pulmonary Edema; Vagus Nerve

Topics: Adult; Aged; Blood Pressure; Cardiac Catheterization; Digoxin; Diuretics; Electrocardiography; Female; Glucose; Heart Ventricles; Hemodynamics; Heparin; Humans; Intensive Care Units; Lidocaine; Male; Middle Aged; Myocardial Infarction; Oscillometry; Partial Pressure; Phonocardiography; Pulmonary Artery; Pulmonary Edema; Radiography

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: 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: Diet Therapy; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Humans; Hypokalemia; Hyponatremia; Morphine; Pulmonary Edema; Rest; Water-Electrolyte Balance

Topics: Adult; Anti-Bacterial Agents; Bicarbonates; Blood Transfusion; Chlorine; Digoxin; Drowning; Humans; Infusions, Parenteral; Intubation, Intratracheal; Lung Compliance; Male; Mannitol; Oxygen; Oxygen Inhalation Therapy; Plasma; Pulmonary Edema; Radiography; Respiration, Artificial; Steroids

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: 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: Cardiomyopathies; Digoxin; Ethiopia; Heart Diseases; Heart Valve Diseases; Humans; Hydrochlorothiazide; Pulmonary Edema; Radiography

Topics: Adolescent; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Electric Countershock; Female; Heart Ventricles; Humans; Male; Middle Aged; Pulmonary Edema; Quinidine; Thromboembolism

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: Adrenal Cortex Hormones; Altitude; Altitude Sickness; Anti-Bacterial Agents; Diagnosis; Digoxin; Diuretics; Drug Therapy; Humans; Hypertension, Pulmonary; Morphine; Oxygen Inhalation Therapy; Pulmonary Edema

Topics: Adrenalectomy; Ascites; Blood Transfusion; Chlorothiazide; Digoxin; Diuretics; Edema; Ethacrynic Acid; Geriatrics; Heart Failure; Humans; Injections, Intravenous; Liver Cirrhosis; Pulmonary Edema