digoxin and Syncope

Although quinidine and digoxin are frequently given together, it has only recently become apparent that serum digoxin concentration may rise during quinidine treatment. A prospective study was performed to compare the effects of quinidine and disopyramide in patients receiving maintenance digoxin therapy. During quinidine administration serum digoxin concentration rose by more than 50% in seven of nine patients (the mean concentration rising from 1.43 +/- 0.20 to 2.61 +/- 0.43 nmol/l, P < 0.005). During the disopyramide treatment a small rise in serum digoxin was noted (mean 1.3 +/- 0.16 to 1.5 +/- 0.19 nmol/l, P < 0.05). We suggest that digoxin doses should be reduced immediately prior to commencing quinidine therapy in patients already receiving adequate maintenance digoxin, and patients should be followed carefully for evidence of digoxin toxicity. Disopyramide appears a suitable alternative anti-arrhythmic drug to quinidine in patients on maintenance digoxin.

Topics: Adult; Aged; Arrhythmias, Cardiac; Digoxin; Disopyramide; Drug Interactions; Female; Humans; Male; Metabolic Clearance Rate; Middle Aged; Pyridines; Quinidine; Syncope

Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall-related injuries and syncope in a real-world older AF cohort.. A retrospective cohort study.. Danish nationwide administrative registries from 2000 to 2015.. A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.. Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).. In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y), and 53 481 (53.0%) were women. During a median follow-up of 2.1 years (IQR = 1.0-5.1), 17 132 (17.0%) experienced a fall-related injury, 5745 (5.7%) had a syncope, and 21 093 (20.9%) experienced either. Compared with rate-lowering monotherapy, AADs were associated with a higher risk of fall-related injuries and syncope. The incidence rate ratio (IRR) for the composite end point was 1.29 (95% confidence interval [CI]: 1.17-1.43) for AAD monotherapy and 1.46 [95% CI = 1.34-1.58] for AAD combined with rate-lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall-related injuries and syncope (IRR = 1.40 [1.26-1.55]). Compared with more than 180 days of rate-lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs.. In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall-related injuries and syncope, and the risk was highest within the first 14 days for those treated with AADs. Only amiodarone use was associated with a higher risk. J Am Geriatr Soc 67:2023-2030, 2019.

Topics: Accidental Falls; Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Cohort Studies; Comorbidity; Denmark; Digoxin; Drug Therapy, Combination; Female; Follow-Up Studies; Fractures, Spontaneous; Head Injuries, Closed; Humans; Male; Retrospective Studies; Syncope

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Antihypertensive Agents; Atorvastatin; Atrial Fibrillation; Bone Density Conservation Agents; Deprescriptions; Digoxin; Diltiazem; Diuretics; Drug Overdose; Factor Xa Inhibitors; Female; Furosemide; Heart Failure; Histamine H1 Antagonists, Non-Sedating; Histamine H2 Antagonists; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Ibandronic Acid; Lisinopril; Loratadine; Metoprolol; Polypharmacy; Pyrazoles; Pyridones; Ranitidine; Syncope

Topics: Acute Kidney Injury; Aged; Ankle Injuries; Anti-Arrhythmia Agents; Antidotes; Digoxin; Female; Fractures, Bone; Humans; Immunoglobulin Fab Fragments; Respiratory Tract Infections; Syncope

Topics: Aged; Atrial Fibrillation; Chronic Disease; Contraindications; Coronary Artery Bypass; Digoxin; Drug Interactions; Electrocardiography; Humans; Hypertension; Male; Postoperative Complications; Quinine; Syncope; Tachycardia, Ventricular; Torsades de Pointes; United Kingdom

Topics: Aged; Amlodipine; Atrial Fibrillation; Digoxin; Female; Graves Disease; Humans; Hypertension, Pulmonary; Methimazole; Recurrence; Syncope; Treatment Outcome; Vertigo

Topics: Bradycardia; Diagnosis, Differential; Digitalis; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Middle Aged; Nausea; Plant Poisoning; Syncope; Vomiting

Topics: Aged; Cardiotonic Agents; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Humans; Hypokalemia; Syncope; Tachycardia, Ventricular; Ventricular Premature Complexes

A 50-year-old man with 'presyncope' is presented. He was found to have an aneurysm of the right coronary sinus of Valsalva and an aneurysm of the noncoronary sinus. Neither aneurysm had ruptured. It is postulated that the patient's symptoms were related to partial obstruction of the right ventricle. Other potential complications of an unruptured aneurysm of the sinus of Valsalva are discussed.

Topics: Aneurysm; Digoxin; Echocardiography; Humans; Male; Middle Aged; Pacemaker, Artificial; Risk Factors; Sinus of Valsalva; Syncope; Tachycardia, Supraventricular

Topics: Aged; Aged, 80 and over; Digoxin; Female; Humans; Nursing Assessment; Poisoning; Syncope

A case of toad venom-induced digitalis toxicity is presented. A pause of 13.5 s was noted in the patient taking a Chinese medication which contained toad venom. This is the first case report of clinical digitalis toxicity related to toad venom in Western society.

Topics: Aged; Aged, 80 and over; Amphibian Venoms; Arrhythmias, Cardiac; Bufanolides; Digoxin; Drugs, Chinese Herbal; Electrocardiography; Humans; Male; Sodium-Potassium-Exchanging ATPase; Syncope

Thirty-two patients with atrial fibrillation and normal ventricular rates who complained of dizziness or loss of consciousness underwent 24-hour ambulatory electrocardiographic monitoring. A control group of 25 patients in atrial fibrillation but without symptoms of dizziness or loss of consciousness was likewise investigated. All patients remained in atrial fibrillation; periods of ventricular standstill (mean, 2.9; range, 1.8-8.0) were present in 31 symptomatic patients but in only three of the control patients (mean, 1.9 s; range, 1.7-2.4). Twenty-three symptomatic patients with pauses greater than or equal to 2.0 s received a demand pacemaker. Following pacing, nineteen became completely asymptomatic; four patients continued to have dizziness but three of these, who also experienced syncope, no longer did so (mean follow-up, 13 months; range, 6-30). It is suggested that ventricular standstill may commonly occur in patients with controlled atrial fibrillation who complain of dizziness or syncope and that the majority will benefit from permanent cardiac pacing.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Chronic Disease; Combined Modality Therapy; Digoxin; Dizziness; Electrocardiography; Female; Heart Block; Heart Ventricles; Humans; Male; Middle Aged; Monitoring, Physiologic; Pacemaker, Artificial; Syncope

Quinidine syncope and factors associated with it are well known among adult patients treated for cardiac arrhythmias. To define factors that may influence the occurrence of syncope in children taking quinidine, the clinical, anatomic, electrocardiographic, roentgenographic and pharmacologic data were compared in six patients with syncope (Group A) and 22 patients without syncope (Group B). There was a significant (chi-square = 10.2, p = 0.001) relation between heart disease and quinidine syncope: all six Group A (syncopal) patients had heart disease whereas 15 of the 22 Group B (non-syncopal) patients had no structural heart disease. In contrast, no significant difference was noted between Group A and Group B patients in mean age (11.4 versus 11.4 years), mean quinidine serum concentration (2.9 versus 2.3 micrograms/ml), mean corrected QT interval before quinidine (0.43 versus 0.40 second) or mean corrected QT interval during quinidine therapy (0.46 versus 0.46 second) or between those taking digitalis and those not. Two of the six Group A (syncopal) patients died during therapy, one 6 days after initiating therapy and one suddenly at home 6 months after beginning quinidine. Another two of the six Group A patients exhibited hypokalemia (both 2.9 mEq/liter) at the time of syncope, 2 weeks and 6 months, respectively, after initiation of quinidine therapy; both survived. Syncope occurred within 8 days of initiation of quinidine therapy in three of the six patients. Sustained ventricular tachycardia was observed during quinidine associated arrhythmia in three of six patients with syncope; nonsustained ventricular tachycardia or complex ventricular ectopic activity while on this therapy was observed before syncope in the other three patients in Group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Child, Preschool; Digitoxin; Digoxin; Drug Administration Schedule; Electrocardiography; Heart Diseases; Hemodynamics; Humans; Quinidine; Syncope

Swallow syncope is an often misdiagnosed rare disorder due to enhanced vagal tone during eating in patients with underlying esophageal and/or cardiac abnormalities. We present three cases of this disorder, one related to digitalis toxicity and the other two with diffuse esophageal spasm. The investigation, differential diagnosis, prognosis and management of swallow syncope are discussed.

Topics: Adult; Deglutition; Diagnosis, Differential; Digoxin; Epilepsy; Esophageal Diseases; Female; Heart Diseases; Humans; Male; Middle Aged; Propantheline; Syncope

Five patients with recurrent syncope or pre-syncope due to rapid supraventricular tachycardias underwent electrophysiological study. In each patient, an AV nodal re-entrant tachycardia could be induced. By leaving a coronary sinus catheter in place, the effects of drugs on the ability to induce tachycardia could be tested on sequential days. Drug effects were highly variable, but in each patient it was possible to determine a drug which prevented induction of tachycardia. Patients treated with this drug have had no recurrent symptoms or tachycardias with a followup of 4-21 months. Although AV nodal re-entry is highly dependent on autonomic tone, electrophysiological study appears to be a useful means of selecting therapy in patients with severe, symptomatic tachycardias.

Topics: Adult; Atrioventricular Node; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Female; Humans; Propranolol; Syncope; Tachycardia

In 12 patients with sinus node syndrome, the influence of Digoxin on the sinus-node function was examined. After having determined the sinus-node recovery time (SNRT), the calculated sinuatrial conduction time (SACT), and the mean cycle length, 1.2 mg Digoxin were applied intravenously; 45 minutes later the above mentioned determinations were repeated. Before applying Digoxin, the mean value of the SNRT was 1665.8 +/- 1381.5 ms, after Digoxin it was 1372.1 +/- 546.1 ms; there was no statistical significance. In regard of the SACT the values were 95.9 +/- 38.6 ms before and 125.0 +/- 31.9 ms after Digoxin (p less than 0.05). The mean cycle length remained almost unchanged (841 +/- 113.2 ms before and 847 +/- 138.4 ms after Digoxin, no significance). Thus it is to be regarded as the clinical therapeutic consequence that in these patients the glycoside application in absence of syncopes or equivalents can be administered in most of the cases without previous pacemaker-implantation. In special cases, however, mainly if there are signs of greater disturbances of the sinus node function and of the SACT, electrophysical functional-analytic examination previous to the Digoxin long-term therapy should be performed.

Topics: Adult; Aged; Digoxin; Electrocardiography; Female; Humans; Male; Middle Aged; Sick Sinus Syndrome; Sinoatrial Node; Syncope

22 patients with syncope and significant aortic stenosis underwent electrophysiological evaluation in addition to the hemodynamic study. Abnormalities of impulse formation or conduction were present in 12 patients. 6 patients demonstrated HV times greater than or equal to 55 msec. There was no correlation between the aortic valve gradient and the HV interval, between the enddiastolic volume of the ventricle and the HV time and between aortic valve calcification and the HV time. Syncopal attacks were corrected with aortic valve replacement even in patients with prolonged HV times.

Topics: Adult; Aged; Aortic Valve; Aortic Valve Stenosis; Bundle of His; Bundle-Branch Block; Calcinosis; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Middle Aged; Pacemaker, Artificial; Recurrence; Syncope

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: Aged; Arrhythmias, Cardiac; Bradycardia; Digoxin; Female; Heart Block; Heart Diseases; Humans; Hypertension; Middle Aged; Pacemaker, Artificial; Sinoatrial Node; Syncope

Topics: Age Factors; Arrhythmia, Sinus; Cardiac Catheterization; Child; Digoxin; Diuretics; Electrocardiography; Heart Atria; Heart Failure; Heart Rate; Humans; Male; Propranolol; Syncope; Tachycardia

Topics: Aged; Deglutition; Digoxin; Electrocardiography; Heart Block; Heart Conduction System; Heart Failure; Humans; Male; Syncope; Vagus Nerve; Vectorcardiography

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

Topics: Adult; Digoxin; Drug Synergism; Electric Countershock; Ethacrynic Acid; Female; Humans; Quinidine; Syncope; Ventricular Fibrillation