digoxin and Shock--Cardiogenic

Topics: Animals; Antidotes; Antivenins; Carbon Monoxide Poisoning; Digoxin; Drug Overdose; Emergency Treatment; Fat Emulsions, Intravenous; Hematologic Diseases; Humans; Hypoglycemic Agents; Immunoglobulin Fab Fragments; Immunoglobulin Fragments; Insulin; Poisoning; Shock, Cardiogenic; Snake Bites; Viperidae

To assess frequencies of various management approaches in cardiogenic shock (CS) and their clinical outcomes. Cardiogenic shock is a state of organ hypoperfusion and hypoxia caused by cardiac failure.. In this retrospective record review, we assessed the presentations, vital signs, laboratory readings, and treatments for 188 consecutive CS inpatients from 2010-2021. Patients were labeled as "ischemic CS" or "non-ischemic CS" based on the occurrence of myocardial infarction as the precipitating cause, and "post-operative CS" if they had undergone cardiac surgery. In-hospital mortality was the primary endpoint of the study.. We identified 118 (62.8%) ischemic, 64 (34%) non-ischemic, and 6 (3.2%) postoperative CS patients. The study population had a high mortality rate (85.1%). Logistic regression analysis revealed that dopamine (. Variations in outcomes occurred with different medications. Mortality was higher in patients receiving dopamine or epinephrine and lower in those receiving dobutamine or digoxin. Implementation of clinical trials for investigation of the mortality benefit observed with dobutamine can serve towards formulation of new guidelines for improvement of CS mortality rates.

Topics: Digoxin; Dobutamine; Dopamine; Epinephrine; Hospital Mortality; Hospitals; Humans; Intra-Aortic Balloon Pumping; Percutaneous Coronary Intervention; Retrospective Studies; Shock, Cardiogenic; Treatment Outcome

Aluminium phosphide (ALP) is a common cause of suicidal poisoning in India where it is easily available and commonly known as 'rice tablet'. In rural areas of India, it is still used to protect rice and stored grains from rodents and pests.

Topics: Acidosis, Lactic; Aluminum Compounds; Cardiotonic Agents; Digoxin; Fluid Therapy; Gastric Lavage; Humans; Hypokinesia; India; Male; Pesticides; Phosphines; Shock, Cardiogenic; Treatment Outcome; Young Adult

The purpose of this study was to report the efficacy of intravenous amiodarone alone or in combination with digoxin in neonates and small infants with life-threatening supraventricular tachyarrhythmia (SVT).. We retrospectively analyzed 9 neonates and small infants with life-threatening or resistant SVT who were treated with intravenous amiodarone alone or in combination with digoxin.. This report consists of 8 patients with reentrant SVT and 1 with atrial flutter. On admission, 7 patients had a congestive heart failure and 3 of whom had cardiovascular collapse. Intravenous rapid bolus of adenosine caused a sustained sinus rhythm in 4 patients. These patients were given digoxin initially, but recurrence of persistent tachyarrhythmia necessitated the use of intravenous amiodarone in all these patients. Amiodarone was given initially to the other 4 patients in whom adenosine caused only temporary conversion to the sinus rhythm. It was effective in 2 patients. In the other 2, digoxin was added to therapy for tachycardia control. Amiodarone alone or in combination with digoxin effectively controlled reentrant SVT in all patients. This combined treatment caused ventricular rate control in patient with atrial flutter, and conversion to the stable sinus rhythm was achieved at approximately 8 months.. Intravenous amiodarone alone or in combination with digoxin was found to be safe and effective in controlling refractory and life-threatening SVT in neonates and small infants.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Evaluation; Drug Therapy, Combination; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Failure; Heart Neoplasms; Heart Rate; Humans; Hypotension; Infant; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Male; Retrospective Studies; Rhabdomyoma; Shock, Cardiogenic; Tachycardia, Supraventricular; Thyrotropin; Treatment Outcome

We present the case of a 75-year-old patient admitted to the emergency department after ingesting a large amount of several cardiac drugs, among which were digoxin and sotalol. Because of renal insufficiency, cardiogenic shock, and high serum digoxin levels, the patient received continuous venovenous hemofiltration (CVVH) and digoxin-specific Fab fragments. Digoxin and the digoxin-specific Fab fragments are normally cleared by the kidneys.. Serum-free and total digoxin and serum sotalol concentrations were monitored for several days.. Less than 10% of the estimated ingested dose of digoxin was cleared by CVVH within 5 days.. CVVH has little influence on the clearance of Fab-bound digoxin from the body. In contrast, sotalol is efficiently cleared by CVVH.

Topics: Aged; Anti-Arrhythmia Agents; Digoxin; Hemofiltration; Humans; Immunoglobulin Fab Fragments; Male; Renal Insufficiency; Shock, Cardiogenic; Sotalol; Time Factors

Two cases in which oral ingestion of beta blocker and slow calcium-channel blocker was associated with profound hypotension and bradycardia are reported, including one case in which serum levels of both drugs were documented in the normal range at a time of severe clinical toxicity. Though unresponsive to usual therapeutic interventions, both patients showed an immediate and dramatic response to intravenous calcium chloride. It is recommended that intravenous calcium chloride be considered in any patient using routine doses of these two agents who presents with hypotension and/or bradycardia.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Atenolol; Calcium Channel Blockers; Calcium Chloride; Digoxin; Diltiazem; Female; Humans; Isoproterenol; Male; Shock, Cardiogenic; Verapamil

Topics: Analgesics; Atropine; Digoxin; Dobutamine; Dopamine; Drug Therapy, Combination; Heart Failure; Heart Rupture; Hemodynamics; Humans; Hypertension; Hypotension; Myocardial Infarction; Propranolol; Shock, Cardiogenic; Vasodilator Agents

Topics: Acute Disease; Cardiac Output; Digitalis Glycosides; Digoxin; Furosemide; Heart Failure; Heart Rate; Heart Ventricles; Humans; Myocardial Contraction; Myocardial Infarction; Oxygen Consumption; Shock, Cardiogenic; Stimulation, Chemical

In 59 digitalized and 3 non digitalized patients the effect of digitalis during the 1st to 4th days after transmural myocardial infarction was controlled. Rhythm disturbances in acute myocardial infarction may arise secondary to a complicating cardiac failure and may be influenced by digitalis. In 9 of 17 cases (53 p.c.) with ventricular or supraventricular extrasystoles daily doses of 0,4 mg beta-Methyldigoxin or 0,4 mg Digoxin i.v. resulted in undisturbed sinus rhythm. In two cases supraventricular tachycardia and extrasystoles with rapid ventricular rate were abolished by 1,2 mg beta-Methyldigoxin within 12 hours, in three other cases an improvement was recorded. Dysrhythmias or other complications did not occur in previously non digitalized patients. When the antiarrhythmic effect of digitalis cannot be obtained cardiodepressive complications by treatment with typical antiarrhythmic agents are diminished. In patients on digitalis and in cardiogenic shock, digitalization should be performed carefully. Intoxication leads to a diminution of cardiac output and to cardiac dysrhythmias.

Topics: Acute Disease; Adult; Aged; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Digitalis Glycosides; Digoxin; Drug Interactions; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Premedication; Shock, Cardiogenic; Tachycardia

In 20 patients with acute myocardial infarction hemodynamic controls were performed after digitalisation and following i.v. injection of 0,4 mg of Prindolol. Circulatory changes were most pronounced 5-15 min after Prindolol injection and consisted of decrease in heart rate of 7%, mean arterial blood pressure of 6%, cardiac output of 10,5%, stroke volume index of 5,1% and left ventricular work of 18%. An increase of pulmonary wedge pressure of 17%, pulmonary pressure of 9%, mean right atrial pressure of 16% and peripheral arterial resistance of 6% were calculated. In 5 cases a favourable effect on extrasystoles and in 2 cases on sinus tachycardia were observed. Not infrequently, during the initial phase of acute myocardial infarction, a hyperadrenergic state may be noted. Prindolol may be indicated, when circulatory changes or arrhythmias are suspect to be the result of this hyperadrenergic stimulation. A simultaneous digitalisation may inhibit a more intensive cardiodepression.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Complexes, Premature; Cardiac Output; Digitalis Glycosides; Digoxin; Female; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Pindolol; Pulmonary Artery; Shock, Cardiogenic; Tachycardia; Time Factors; Vascular Resistance

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

Of the 27 patients described, 23 were in cardiogenic shock, 2 had severe left ventricular failure, and 2 had medically refractory ventricular tachycardia. Utilizing intraaortic counterpulsation, adequate systemic blood pressure was initially restored in 19 patients. Nine of these were subsequently weaned from circulatory assistance, but only three were discharged from the hospital and are currently alive. The remaining 10 patients who derived initial benefit from circulatory assistance were balloon-dependent in that they could not be weaned from circulatory assistance. Eight of these patients subsequently underwent cardiac catheterization; four had inoperable disease. The remaining four patients underwent surgery for either resection of the area of infarction and/or for myocardial revascularization; only one survived to subsequently leave the hospital. Ventricular volumes were abnormal and ejection fractions were below 30 per cent in all the patients in cardiogenic shock except one who underwent cardiac catheterization and ultimately died. Ejection fractions were greater than 30 per cent in the two patients with cardiogenic shock who were weaned from balloon support and survived to leave the hospital without surgery. Both of these patients had inferior myocardial infarction. The data obtained from this experience suggest that intraaortic counterpulsation is a very useful adjunct to currently existing medical measures to treat both cardiogenic shock and medically refractory left ventricular failure but that most patients have such extensive disease that they can neither be weaned from balloon support nor undergo successful infarctectomy or myocardial revascularization.

Topics: Adult; Aged; Assisted Circulation; Blood Pressure; Cardiac Catheterization; Cardiac Volume; Digoxin; Diuretics; Female; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Plasma Substitutes; Shock, Cardiogenic; Tachycardia

Topics: Adult; Digoxin; Female; Heart Failure; Heart Rate; Humans; Hypertension; Injections, Intravenous; Male; Middle Aged; Shock, Cardiogenic

Topics: Blood Pressure; Cardiac Output; Digoxin; Drug Evaluation; Ferricyanides; Furosemide; Heart Failure; Humans; Infusions, Parenteral; Isosorbide Dinitrate; Male; Middle Aged; Nitric Oxide; Pulmonary Circulation; Shock, Cardiogenic; Spironolactone; Vasodilator Agents

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: Blood Pressure; Digitalis Glycosides; Digoxin; Humans; Lanatosides; Ouabain; Shock, Cardiogenic; Vascular Resistance

Topics: Arrhythmias, Cardiac; Atropine; Diet Therapy; Digoxin; Electrocardiography; Female; Furosemide; Heart Block; Heart Failure; Heparin; Hospitalization; Humans; Hypotension; Male; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Oxygen Inhalation Therapy; Progressive Patient Care; Shock, Cardiogenic

Topics: Blood Pressure; Body Surface Area; Carbon Dioxide; Cardiac Catheterization; Cardiac Output; Collateral Circulation; Digoxin; Electrocardiography; Glucagon; Heart Failure; Humans; Isoproterenol; Lung; Myocardial Infarction; Norepinephrine; Oxygen; Positive-Pressure Respiration; Pulmonary Artery; Pulmonary Circulation; Shock, Cardiogenic

Topics: Adult; Aged; Arrhythmias, Cardiac; Bradycardia; Coronary Care Units; Digoxin; Diuretics; Electrocardiography; Female; Heart Atria; Heart Block; Heart Failure; Heart Ventricles; Hospitals, Teaching; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Shock, Cardiogenic; Tachycardia; Ventricular Fibrillation

Topics: Digoxin; Electric Countershock; Emergencies; Humans; Lidocaine; Metaproterenol; Prognosis; Shock, Cardiogenic; Tromethamine

Topics: Adult; Aged; Blood Pressure; Cardiac Output; Dextrans; Digoxin; Electrocardiography; Epinephrine; Heart Ventricles; Humans; Isoproterenol; Middle Aged; Myocardial Infarction; Norepinephrine; Phlebography; Pulmonary Artery; Shock, Cardiogenic; Vascular Resistance

Topics: Cardiac Output; Digitoxin; Digoxin; Heart; Heart Failure; Heart Rate; Humans; Myocardial Infarction; Potassium Chloride; Shock, Cardiogenic

Topics: Aged; Digoxin; Female; Glucagon; Hemodynamics; Humans; Isoproterenol; Male; Myocardial Infarction; Shock, Cardiogenic

Topics: Adult; Aged; Blood Pressure; Cardiac Output; Digoxin; Female; Heart Failure; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Shock, Cardiogenic

Topics: Angina Pectoris; Coronary Disease; Digoxin; Electrocardiography; Hydrochlorothiazide; Hypercholesterolemia; Hypertension; Metaraminol; Nitroglycerin; Shock; Shock, Cardiogenic; Vasopressins; Warfarin