digoxin and Rheumatic-Heart-Disease

Topics: Adolescent; Captopril; Cardiomyopathies; Child; Digoxin; Dobutamine; Dopamine; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Furosemide; Heart; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hydralazine; Isoproterenol; Nitroprusside; Physical Examination; Radionuclide Imaging; Rheumatic Heart Disease

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

It has been suggested that patients in whom atrial fibrillation (AF) is associated with poor exercise tolerance respond better to treatment with xamoterol plus digoxin than to digoxin alone; this may be attributable to better control of exercise induced tachycardia. We have examined data obtained during studies comparing digoxin and two calcium antagonists in the treatment of AF to see whether subgroups of patients with particularly poor exercise tolerance, rheumatic heart disease or rapid post-exercise heart rates might derive particular benefit from one modality of treatment as opposed to another. The results do not indicate that calcium antagonists improve exercise tolerance compared with digoxin in any of these subgroups despite achieving consistently better control of exercise induced tachycardia.

Topics: Atrial Fibrillation; Calcium Channel Blockers; Clinical Trials as Topic; Digoxin; Diltiazem; Double-Blind Method; Heart Rate; Humans; Physical Exertion; Random Allocation; Rheumatic Heart Disease; Verapamil

The results of studying the clinical effect of the diuretic soldacton and its effect on a number of indices of water-electrolyte metabolism are discussed. The drug was used in 16 patients with IIB--III stage of circulatory insufficiency. It was found that soldacton possesses a moderate diuretic and natriuretic effect and produces a potassium-preserving effect. The drug is effective in various initial concentrations of plasma aldosterone which does not change significantly under its effect. Soldacton promotes improvement of tolerance to cardiac glycosides and diminishes the risk of the development of digitalis intoxication.

Topics: Adult; Aged; Aldosterone; Canrenoic Acid; Cardiovascular Diseases; Chronic Disease; Clinical Trials as Topic; Coronary Disease; Digoxin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Pregnadienes; Pulmonary Heart Disease; Rheumatic Heart Disease; Water-Electrolyte Balance

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

Topics: Aged; Clinical Trials as Topic; Coronary Disease; Digoxin; Female; Heart Diseases; Humans; Hypertension; Male; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

Digoxin is widely used in patients with rheumatic heart disease (RHD) despite a lack of data on its impact on clinical outcomes. We aimed to determine the association of digoxin use on clinical outcomes in patients with RHD.. We performed a retrospective analysis of the association of digoxin use with mortality at 2 years in a large RHD registry. Secondary outcomes were recurrent heart failure (HF) and hospitalisation for any cause. We assessed associations using multivariable logistic regression in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. We also estimated average treatment effects from propensity-adjusted analyses using inverse probability treatment weighting.. Information on digoxin use at baseline was available for 98.7% (3298/3343) of patients. In the overall population, digoxin was significantly associated with mortality (OR 1.63, 95% CI 1.30 to 2.04, p<0.0001) and recurrent HF (OR 1.48, 95% CI 1.07 to 2.04, p=0.019). On propensity-weighted analyses, this effect was markedly attenuated (OR 1.05, 95% CI 1.01 to 1.09, p=0.005). Patients in sinus rhythm without HF had a higher propensity-adjusted odds of death with digoxin use (OR 1.06, 95% CI 1.01 to 1.12, p=0.015), but those with both AF and HF had lower mortality (OR 0.88, 95% CI 0.80 to 0.98, p=0.019).. Digoxin use is associated with higher mortality in patients with RHD, but this is greatly attenuated on propensity adjustment, indicating the presence of substantial treatment bias. The adjusted estimates may therefore not be reliable, and large randomised trials are needed to determine the true effect of digoxin in patients with RHD.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiotonic Agents; Digoxin; Female; Global Health; Heart Failure; Humans; Male; Middle Aged; Mortality; Outcome Assessment, Health Care; Propensity Score; Registries; Rheumatic Heart Disease

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Humans; Registries; Rheumatic Heart Disease

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

Calcification of soft tissues, such as heart valves and tendons, is a common clinical problem with limited therapeutics. Tissue specific stem/progenitor cells proliferate to repopulate injured tissues. But some of them become divergent to the direction of ossification in the local pathological microenvironment, thereby representing a cellular target for pharmacological approach. We observed that HIF-2alpha (encoded by EPAS1 inclined form) signaling is markedly activated within stem/progenitor cells recruited at calcified sites of diseased human tendons and heart valves. Proinflammatory microenvironment, rather than hypoxia, is correlated with HIF-2alpha activation and promoted osteochondrogenic differentiation of tendon stem/progenitor cells (TSPCs). Abnormal upregulation of HIF-2alpha served as a key switch to direct TSPCs differentiation into osteochondral-lineage rather than teno-lineage. Notably, Scleraxis (Scx), an essential tendon specific transcription factor, was suppressed on constitutive activation of HIF-2alpha and mediated the effect of HIF-2alpha on TSPCs fate decision. Moreover, pharmacological inhibition of HIF-2alpha with digoxin, which is a widely utilized drug, can efficiently inhibit calcification and enhance tenogenesis in vitro and in the Achilles's tendinopathy model. Taken together, these findings reveal the significant role of the tissue stem/progenitor cells fate decision and suggest that pharmacological regulation of HIF-2alpha function is a promising approach for soft tissue calcification treatment.

Topics: Achilles Tendon; Aged; Animals; Basic Helix-Loop-Helix Transcription Factors; Calcinosis; Cell Differentiation; Cell Proliferation; Cells, Cultured; Cellular Microenvironment; Chondrogenesis; Digoxin; Humans; Male; Middle Aged; Rats; Rheumatic Heart Disease; Stem Cells; Therapy, Soft Tissue

In a woman with rheumatic heart disease, atrial flutter with a rapid ventricular response, and congestive heart failure, treatment with digoxin slows conduction in the atrioventricular node and thus allows atrioventricular conduction to occur by way of a previously unrecognized accessory pathway.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Atrioventricular Node; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Middle Aged; Rheumatic Heart Disease; Tachycardia, Ventricular

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

Fluorescence polarization immunoassay was used to study the chronopharmacokinetics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum digoxin concentration reached peak value 1 h after taking digoxin at 7:00 a.m., but the serum digoxin concentration reached the peak value 2 h after taking digoxin at 4:00 p.m. The average serum digoxin concentration area under curve was greater and the best maintainable time of serum concentration within 24 h after taking digoxin at 4 p.m. longer than those at 7:00 a.m. The heart rates were obviously lower and the cardiac function was significantly improved in 4:00 p.m. group.

Topics: Adult; Aged; Chronotherapy; Coronary Disease; Digoxin; Female; Heart Failure; Humans; Male; Middle Aged; Rheumatic Heart Disease

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

Topics: Atrial Fibrillation; Cardiac Complexes, Premature; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Middle Aged; Poisoning; Rheumatic Heart Disease

Topics: Cardiomyopathy, Dilated; Chronic Disease; Digoxin; Diuretics; Drug Evaluation; Drug Therapy, Combination; Exercise Tolerance; Heart Failure; Hemodynamics; Humans; Middle Aged; Ramipril; Rheumatic Heart Disease; Time Factors

Ventricular arrhythmias were analysed in 38 patients with Stages I-IIB heart failure from 24-hour Holter monitoring data obtained before and after digoxin therapy by comparing with the concentrations of catecholamines. There was a direct relationship between the plasma levels of epinephrine and norepinephrine and the severity of ventricular arrhythmias, as well as between the changes in cumulative catecholamine levels and ventricular arrhythmias during digoxin therapy. Virtually in all cases, the antiarrhythmic effect of the drug was accompanied by lower plasma catecholamine concentrations whereas the levels of norepinephrine and epinephrine remained nearly unchanged or increased with the tentatively arrhythmogenic action. The findings may suggest that hypercatecholaminemias are essential in the genesis of ventricular arrhythmias in heart failure. Cardiac glycosides can heterogeneously affect ventricular arrhythmias by modifying the activity of the sympathoadrenal system.

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Cardiomyopathy, Dilated; Coronary Disease; Digoxin; Epinephrine; Female; Heart Failure; Humans; Male; Middle Aged; Norepinephrine; Pituitary-Adrenal System; Rheumatic Heart Disease; Sympathetic Nervous System

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

Topics: Adult; Aged; Atrial Fibrillation; Digoxin; Drug Incompatibility; Drug Monitoring; Female; Humans; Male; Middle Aged; Quinidine; Rheumatic Heart Disease

Topics: Adult; Digoxin; Drug Therapy, Combination; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Molsidomine; Nifedipine; Rheumatic Heart Disease

Determination of serum endogenous digitalis-like factor (EDF) concentration was carried out in 52 patients with chronic congestive heart failure with radioimmunoassay. The results showed that concentration of serum EDF in patients with chronic congestive heart failure was significantly lower than that in normal subjects (P less than 0.001). The lowering of serum EDF concentration was significantly negatively correlated with the severity of heart failure, r = 0.6475, P less than 0.001. Age had no significant effect on serum EDF concentration (P greater than 0.05). Serum EDF concentration rose after the heart failure was treated, but was still lower than that in normal subjects (P less than 0.01). Serum EDF concentration in patients with coronary heart disease was the lowest and in patients with hypertension the highest.

Topics: Adult; Aged; Aged, 80 and over; Blood Proteins; Cardenolides; Coronary Disease; Digoxin; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Radioimmunoassay; Rheumatic Heart Disease; Saponins; Sodium-Potassium-Exchanging ATPase

Topics: Administration, Oral; Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Digoxin; Female; Heart Failure; Humans; Long-Term Care; Male; Middle Aged; Patient Compliance; Rheumatic Heart Disease

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

With ever increasing frequency potentially dangerous interactions are reported between Cardiac Glycosides and other drugs, particularly the antiarrhythmic one. The AA, carried out this work with the intent of studying the possible modifications produced by Q and A on the SDL. First of all the AA. retrospectively studied the SDL of patients treated with the associations Q-D and A-D and this SDL was compared with the SDL of patients treated with D alone. Then 10 subjects treated sequentially, at first with D alone and after with the Q-D (5 p.) and A-D (5 p.) association, were studied. The results obtained confirm the data of other AA. regarding the Q-D interaction; in fact, in the presence of this antiarrhythmic drug, the SDL increase significantly following the concomitant pharmacological effects of the Cardiac Glycosides. The SDL on the contrary seem not be influenced by the A-D association. The AA. then reviewed the literature about the mechanism of the Q-D interaction. The majority of the AA. agree outlining a reduction of the Volume of Distribution and of D Clearance, in consequence of the concomitant administration of Q, which would explain the high SDL obtained. In conclusion the AA. suggest, when the Q-D association is mandatory, a 50% reduction of the D maintenance dose and to check periodically the ECG and SDL.

Topics: Adult; Aged; Amiodarone; Benzofurans; Coronary Disease; Digoxin; Drug Interactions; Female; Heart Diseases; Humans; Hypertension; Male; Middle Aged; Quinidine; Rheumatic Heart Disease

Ten cases of chaotic atrial tachycardia (CAT) in childhood are reported. Patients' ages ranged from 1 day to 18 years (average, 3.5 years) at the time of diagnosis. The patients were divided into groups according to the following criteria: (1) no cardiac disease (n = 5), (2) congenital heart disease (n = 4), and (3) acquired heart disease (n = 1). Nine of the children were treated with digoxin; however, it appears there was no beneficial effect. In fact, the single death in our study group may have been attributable to digitalis intoxication. No children have had recurrence of the arrhythmia after discontinuation of the drug. The duration of the tachyarrhythmia was extremely variable; however, CAT was well tolerated and was self-limiting in our patients.

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Chronic Disease; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Propranolol; Quinidine; Rheumatic Heart Disease; Tachycardia

One hundred and twenty-two patients with cardiac disease were compared with 250 controls with respect to the duration of pregnancy and labour, birth weight percentile and Apgar score. The babies of the patients with cardiac disease were light-for-dates (18% below the 10th percentile); the mothers, if multiparous, delivered at an earlier gestational age. The patients with cardiac disease did not have shorter labours than the control group. Digoxin administration and the severity of heart disease had no significant effect on these variables.

Topics: Apgar Score; Birth Weight; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Humans; Infant, Low Birth Weight; Infant, Newborn; Labor, Obstetric; Parity; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease

The bioaccessibility of Soviet produced digoxin tablets in elderly patients with cardiac insufficiency was studied. It is shown that in absolute bioaccessibility (62%) and other biopharmaceutic indices digoxin tablets made in the Soviet Union are equivalent to lanoxin tablets of the Burroughs Wellcome firm which are accepted by the USA FDA as the bioaccessibility standard. Equations fitted within a two-part mathematical model satisfactorily describe the changes in blood serum digoxin concentration in oral medication and in intravenous administration.

Topics: Aged; Biological Availability; Coronary Disease; Digoxin; Heart Failure; Humans; Male; Rheumatic Heart Disease; Tablets; Therapeutic Equivalency; Time Factors

Topics: Digoxin; Heart Valve Diseases; Humans; Myocardial Contraction; Rheumatic Heart Disease; Strophanthins

Topics: Adult; Aged; Chronic Disease; Coronary Disease; Digoxin; Drug Therapy, Combination; Female; Humans; Hypertension; Middle Aged; Propranolol; Rheumatic Heart Disease

Topics: Adolescent; Adult; Digoxin; Drug Evaluation; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Rheumatic Heart Disease; Spirometry

Topics: Adult; Aged; Ambulatory Care; Coronary Disease; Digoxin; Female; Humans; Male; Middle Aged; Rheumatic Heart Disease; Time Factors

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

Topics: Adult; Aged; Biological Availability; Coronary Disease; Digoxin; Drug Labeling; Humans; Israel; Legislation, Drug; Male; Medication Errors; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease

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

The structure of cardiac rhythm was studied with the help of specialized computers during digitalization in 60 patients with atrial fibrillation of different etiology. The reduction of the heart contractions rate under digitalization is accompanied by certain changes in the structure of cardiac rhythm: the arrhythmic pattern of the ventricular contractions increases with a predominant growth of the number of long R--R intervals, the transitions from short intervals to longer ones become sharper, and portions of a relatively stable ventricular rhythm appear. Three main types of dynamics of the rhythm structure were distinguished on the basis of the changes in the interval R--R histogram. The described changes in the structure of cardiac rhythm are not specific, but when Digitalis drugs are used alone they can be used as additional criteria for digitalization.

Topics: Adult; Aged; Atrial Fibrillation; Atrioventricular Node; Coronary Disease; Digoxin; Electrocardiography; Heart Conduction System; Humans; Hyperthyroidism; Middle Aged; Rheumatic Heart Disease

Topics: Digoxin; Female; Humans; Milk, Human; Rheumatic Heart Disease

Topics: Adult; Aged; Biopharmaceutics; Chronic Disease; Coronary Disease; Digitalis Glycosides; Digoxin; Dose-Response Relationship, Drug; Drug Evaluation; Female; Heart Failure; Humans; Male; Middle Aged; Rheumatic Heart Disease

Topics: Adult; Aged; Amiodarone; Atrial Fibrillation; Atrial Flutter; Benzofurans; Digoxin; Female; Humans; Male; Middle Aged; Myocardial Infarction; Pulmonary Heart Disease; Rheumatic Heart Disease

There were 29 patients with rheumatic heart disease and early stages of cardiac insufficiency under observation. Spiroergometry with the "Ergotest" device was conducted in dynamics to check whether the proper dose of the cardiac glycoside had been chosen. The results attest to the considerable improvement in the spiroergometric indices in patients with early stages of cardiac insufficiency who had been treated with digitalis. Spiroergometry yielded important additional criteria of the effectiveness of digitalization, particularly in individuals with normal or diminished rate of cardiac contractions.

Topics: Adolescent; Adult; Digoxin; Drug Evaluation; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Contraction; Respiration; Rheumatic Heart Disease; Spirometry

Serum magnesium estimation was done in 19 children who had heart failure of varied etiology. Five of nine toxic patients and three of 10 nontoxic ones had magnesium deficiency (serum magnesium less than 1.5 mEq. per liter). Mean serum magnesium level was significantly lowered (P less than 0.01) in 19 children and it was further lowered in nine toxic patients (P less than 0.001) as well as in eight hypomagnesemic patients (P less than 0.001) than in healthy control subjects. Mean serum digoxin level in toxic patients was significantly higher than in nontoxic ones (P less than 0.05). In three cases magnesium sulfate was successfully used for the management of cardiac arrhythmias.

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Magnesium; Magnesium Deficiency; Magnesium Sulfate; Rheumatic Heart Disease

The clinical course, through pregnancy and delivery, of a 30-year-old woman with rheumatic heart disease and a prosthetic mitral valve is presented. Despite maternal development of congestive cardiac failure and atrial fibrillation, the delivery of a healthy infant was achieved. The problems encountered during pregnancy and delivery in patients with rheumatic heart disease and prosthetic valves are discussed. These include the management of long-term anticoagulant therapy, prophylaxis against rheumatic fever and subacute bacterial endocarditis, impaired cardiac function, atrial fibrillation, breast feeding, and contraception as they relate both to the mother and the fetus and infant.

Topics: Adult; Atrial Fibrillation; Breast Feeding; Digoxin; Endocarditis, Subacute Bacterial; Female; Fetus; Heart Failure; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Penicillin G Benzathine; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Rheumatic Fever; Rheumatic Heart Disease; Sulfadiazine; Warfarin

Blood concentrations of Digoxin were determined by radioimmuno-assay in 80 patients with different stages of circulatory insufficiency receiving maintenance therapy with Digoxin, 0.25-0.75 mg/day. The range of Digoxin concentration fluctuations is very wide--from 0.25 to 2.4 ng/ml. Some elevation of Digoxin concentration in blood was observed when the dose of the drug was increased, both in different groups of patients, and in the same patients when the maintenance dose was altered. Studies conducted during digitalis intoxication in 4 patients demonstrated different levels of Digoxin concentration in blood--from 0.8 to 2.6 ng/ml. The obtained results permitted to conclude that the concentration of Digoxin in blood has no significance in choosing the optimum therapeutic dose, unless the clinical data are taken into account.

Topics: Adult; Aged; Biopharmaceutics; Coronary Disease; Digoxin; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Radioimmunoassay; Rheumatic Heart Disease

Clinical, electrocardiographic and laboratory data were found out in 52 patients with cardiac arrhythmias and conduction defects due to digoxin intoxication. Forty six nontoxic patients were also studied for comparison. Blood urea concentration was significantly higher in toxic patients as compared to nontoxic ones (P less than 0-01). Ventricular bigeminy and trigeminy (38.6%), multifocal ventricular premature beats (25%) and second or third degree A-V blocks (25%) were very much prevalent. Fairly good correlations have been observed between different cardiac arrhythmias and serum digoxin levels. Significantly higher mean serum digoxin levels were observed in patients with A-V block and multifocal ventricular premature beats as compared to patients with supraventricular arrhythmias.

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Female; Heart Block; Heart Failure; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia; Ventricular Fibrillation

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: Adrenal Cortex Hormones; Adult; Arm; Digoxin; Female; Furosemide; Humans; Leg; Photosensitivity Disorders; Quinidine; Rheumatic Heart Disease; Vascular Diseases

Topics: Adult; Anticoagulants; Digoxin; Dipyridamole; Female; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Quinidine; Rheumatic Heart Disease; Warfarin

Topics: Adult; Aged; Digoxin; Female; Fetus; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Maternal-Fetal Exchange; Middle Aged; Pregnancy; Pregnancy Complications, Cardiovascular; Radioimmunoassay; Rheumatic Heart Disease; Umbilical Cord

Topics: Arrhythmias, Cardiac; Arteriosclerosis; Cardiac Output; Coronary Disease; Digoxin; Heart Rate; Humans; Intestinal Absorption; Rheumatic Heart Disease

Topics: Adult; Diagnosis, Differential; Digitalis Glycosides; Digoxin; Electrocardiography; Endocarditis, Subacute Bacterial; Female; Humans; Hypercalcemia; Hyperkalemia; Prednisone; Rheumatic Heart Disease; Substance-Related Disorders

Topics: Administration, Oral; Adult; Age Factors; Aged; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Electrocardiography; Female; Humans; Hypothyroidism; Male; Middle Aged; Nausea; Potassium; Radioimmunoassay; Rheumatic Heart Disease; Urea; Vomiting

Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Coronary Disease; Digoxin; Electrocardiography; Heart Block; Humans; Hypertension; Ischemic Attack, Transient; Middle Aged; Rheumatic Heart Disease; Syncope; Tachycardia

Topics: Adolescent; Adult; Aged; Bundle-Branch Block; Cardiac Catheterization; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Diseases; Humans; Male; Middle Aged; Rheumatic Heart Disease

Topics: Acute Disease; Adult; Aspirin; Child; Demography; Digoxin; Female; Hospitalization; Humans; Male; Penicillin G Benzathine; Penicillins; Phenobarbital; Rheumatic Fever; Rheumatic Heart Disease; Socioeconomic Factors; Steroids; Streptococcus; Sulfadiazine; Virginia

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

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; Aged; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Female; Humans; Male; Middle Aged; Rheumatic Heart Disease

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Coronary Disease; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

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

Topics: Adolescent; Arrhythmias, Cardiac; Child; Digoxin; Heart Defects, Congenital; Humans; Hypokalemia; Infant; Infant, Newborn; Rheumatic Heart Disease; Toxicology

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