digoxin and Syndrome

There is no robust evidence that any treatment can modify the natural history of patients with heart failure and preserved left ventricular ejection fraction (HFpEF), although most agree that diuretics can control congestion and improve symptoms. HFpEF is often complicated by systemic and pulmonary hypertension, atrial fibrillation, obesity, chronic lung and kidney disease, lack of physical fitness, and old age that can complicate both diagnosis and management. Further trials should phenotype patients precisely and create better definitions of HFpEF based on biomarkers.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin-Converting Enzyme Inhibitors; Digoxin; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Middle Aged; Piperazines; Prognosis; Purines; Randomized Controlled Trials as Topic; Reference Values; Risk Assessment; Sildenafil Citrate; Stroke Volume; Sulfonamides; Survival Analysis; Syndrome; Treatment Outcome; Ventricular Function, Left

The pharmacologic management of acute heart failure syndromes (AHFS) has changed little over the past 15 years. Traditional therapies, such as nitrates and loop diuretics, remain the mainstay of therapy, with inotropes reserved for patients who present in shock or an advanced low-output state. We review the use of these therapies in AHFS with added insights from recent clinical trials and registry data.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Milrinone; Mineralocorticoid Receptor Antagonists; Morphine; Nitroprusside; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Survival Analysis; Syndrome; Treatment Outcome

Several treatment strategies exist for patients hospitalized with acute heart failure syndromes (AHFS). These therapies traditionally focus on improving hemodynamics and relieving congestion. This review focuses on noninodilator therapies, including diuretics, nitrovasodilators (nitroprusside and nitroglycerin), vasodilators (nesiritide), digoxin, and intravenous angiotensin-converting enzyme inhibitors. These agents are used based on their associated symptomatic improvements alone. In the hospitalized setting, none of these agents have demonstrated benefits on long-term outcomes. Future work in AHFS should strive to understand the influence of conventional and new pharmacologic therapies on the underlying pathophysiology of AHFS, the processes that lead to myocardial injury and progressive heart failure, and measurable clinical outcomes.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Digoxin; Diuretics; Heart Failure; Humans; Natriuretic Peptide, Brain; Nitroglycerin; Nitroprusside; Severity of Illness Index; Syndrome; Vasodilator Agents

The electrical stability of the heart is more sensitive to the extracellular than to the intracellular potassium concentration. During exercise, extracellular potassium varies rapidly. Catecholamines also modulate the plasma potassium concentration. Hypokalaemia of any cause can precipitate arrhythmias. Ischaemic myocardium loses potassium into the extracellular space within seconds and the cell becomes depolarized. The rise of the extracellular potassium ion concentration accounts for many of the early electrophysiological changes. Abrupt changes of plasma potassium concentration in normal myocardium and a high potassium concentration in ischaemic myocardium can set up electrical forces which initiate arrhythmias. The same phenomenon can account for changes on the electrocardiogram early after the cessation of an exercise test in a patient with ischaemic heart disease. Accumulation of potassium between cells in response to an increase of heart rate is a possible mechanism for false positive exercise tests and Syndrome X.

Topics: Acidosis; Action Potentials; Angioplasty, Balloon; Animals; Catecholamines; Coronary Disease; Digoxin; Diuretics; Exercise Test; False Positive Reactions; Heart; Heart Rate; Humans; Hyperkalemia; Hypokalemia; Myocardium; Physical Exertion; Potassium; Syndrome

The dilated cardiomyopathy with ataxia syndrome (DCMA) is a rare mitochondrial disorder characterized by progressive cardiomyopathy, prolonged QT interval and early death in childhood related to intractable heart failure. We present a case series of 9 children with DCMA who demonstrated functional improvement and favourable left ventricular remodeling only after digoxin was added to their medical therapy.. A retrospective review of 46 patients with DCMA followed at the Alberta Children's Hospital from 2005 to 2017 identified 9 patients who were treated with digoxin and had serial echocardiography data. For each subject, we calculated the difference between baseline and follow-up for left ventricular ejection fraction (LVEF), end-diastolic dimension (LVEDD), and end-systolic dimension (LVESD) as determined by echocardiography.. Patients were on average 45.6 ± 59 months of age when digoxin was started with a mean LVEF of 40% ± 11% when digoxin was started. Seven patients were on angiotensin-converting enzyme inhibitors (ACEIs) at the time of initiation of digoxin, and all were on β-receptor antagonists (BB). After being on digoxin for a mean of 11.7 ± 10.9 months, average LVEF improved to 55% ± 10% (P = 0.0005), and there were significant decreases in the Z-scores for LVEDD (+2.1 ± 1.9 to +0.65 ± 1.4, P = 0.02) and LVESD (+3.83 ± 2.07 to +1.79 ± 1.76, P = 0.01).. In children with DCMA, we report that digoxin seems to have additive beneficial properties when combined with ACEI and BB therapy. This novel observation may have implications for the medical treatment of mitochondrial cardiomyopathies.

Topics: Ataxia; Cardiomyopathy, Dilated; Cardiotonic Agents; Child, Preschool; Digoxin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Infant; Male; Retrospective Studies; Stroke Volume; Syndrome; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling

Topics: Ataxia; Cardiomyopathies; Cardiomyopathy, Dilated; Child; Digoxin; Humans; Syndrome

Topics: Acute Disease; Aged; Anti-Arrhythmia Agents; Blood Pressure; Cardiac Surgical Procedures; Coronary Angiography; Coronary Disease; Digoxin; Electrocardiography; Female; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Patient Admission; Platelet Glycoprotein GPIIb-IIIa Complex; Prospective Studies; Sex Factors; Stroke Volume; Syndrome; Thrombolytic Therapy; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left

The expanded toxemia syndrome or gestosis refers to polysymptomatic diseases that are associated with pregnancy. This report discusses those cases without initial hypertension or proteinuria that were "cured" by delivery and were associated with maternal and fetal morbidity (usually intrauterine growth retardation). A list of suggested tests is presented to document gestosis in pregnant women with medical illnesses. Unlike preeclampsia, gestosis may occur at almost any time in pregnancy.

Topics: Chorionic Gonadotropin; Digoxin; Female; Fetal Growth Retardation; Humans; Hypertension; Placenta; Plasma Volume; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Regional Blood Flow; Syndrome

Topics: Digoxin; Eosinophilia; Female; Heart Failure; Humans; Middle Aged; Prednisone; Syndrome

We have studied a patient with hypereosinophilic syndrome (HES) who initially presented with recurrent asthmatic attacks followed by progressive dyspnea. Chronic obstructive lung disease was suspected at first although involvement of cardiac and other organ systems and marked eosinophilia eventually led to the diagnosis. Thereafter a diffuse interstitial pattern gradually developed on the chest radiograph which persisted despite vigorous treatment for cardiac failure. This was due to infiltration and cuffing of the small pulmonary arteries by eosinophils. The bronchi showed changes consistent with asthma. Review of the literature indicates that this type of vascular change is common in HES but involves predominantly organs other than the lung. Similar pulmonary arterial changes have been produced experimentally in the calf by prolonged intravenous infusion of antibiotics, indicating that this may be a hypersensitivity reaction to a blood-borne material entering the pulmonary circulation.

Topics: Aged; Autopsy; Bronchodilator Agents; Digoxin; Eosinophilia; Female; Furosemide; Heart Failure; Humans; Intracranial Embolism and Thrombosis; Lung Diseases, Obstructive; Prednisone; Pulmonary Artery; Syndrome

Topics: Adult; Anti-Arrhythmia Agents; Aprindine; Arrhythmias, Cardiac; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Humans; Indenes; Syndrome

Topics: Acidosis; Acidosis, Renal Tubular; Amiloride; Animals; Chlorides; Digoxin; Dogs; Electrolytes; Humans; Hypokalemia; Lithium; Syndrome; Tromethamine

The prolonged QT interval syndrome without hearing loss (Romano-Ward syndrome) is described in three families with 48 affected members. Syncope or dizziness caused by different ventricular tachyarrhythmias were the presenting symptoms in the symptomatic patients. Four of the subjects died suddenly. Right stellate ganglionectomy was performed in one patient in order to abolish the ventricular dysrhythmia. beta-blockers are considered the drug of choice in patients with hereditary prolonged QT interval; if the beta-blockers fail to abolish the syncopal attacks of severe bradycardia complicates the clinical course, a pharmacological blockade of the stellate ganglia should be performed and its results carefully evaluated in order to establish whether a stellate ganglionectomy is justified.

Topics: Adult; Arrhythmias, Cardiac; Child; Digoxin; Female; Humans; Isoproterenol; Male; Pedigree; Propranolol; Syndrome; Tachycardia

A family had an unusual and perhaps unique familial dysrhythmia. The proband had a short PR interval with normal QRS and chronic recurrent paroxysmal atrial tachycardia (Lown-Ganong-Levine syndrome). The arrhythmia produced left ventricular dysfunction. Both paroxysmal atrial tachycardia (PAT) and left ventricular dysfunction were reversed with administration of digoxin and propranolol hydrochloride. Three family members had paroxysmal or chronic atrial fibrillation, first diagnosed at a relatively young age (23 years, 38 years, and early 40s, respectively). Five additional family members had short PR intervals with normal QRS, and eight other family members had borderline short PR intervals. The mode of inheritance appeared to be autosomal dominant with varying expressivity. We have described a familial syndrome characterized by PAT or atrial fibrillation in its advanced form with short PR interval as a possible identifying trait. The future course of members with isolated short PR is unknown.

Topics: Adult; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Male; Pedigree; Propranolol; Syndrome; Tachycardia, Paroxysmal

Topics: Arrhythmia, Sinus; Bronchopneumonia; Digoxin; Electrocardiography; Humans; Infant; Male; Syndrome; Tachycardia

Five patients were seen at the Mayo Clinic over an 8-year period with the following complex of clinical and morphologic features; striking eosinophilia, cardiomyopathy, hepatosplenomegaly, and either a rapidly fatal or a prolonged, debilitating illness. In recent years, controversy has raged over the precise designation of this syndrome, with proposals ranging from eosinophilic leukemia to hypereosinophilic syndromes. To focus on the major target organ of the disease, we have favored the term endomyocardiopathy with eosinophilia. Experience with these five patients showed that (1) eosinophilia can persist for many years before symptoms appear; (2) progressive restrictive cardiac disease was the major cause of death and debility; (3) osmiophilic cytoplasmic inclusions are present in eosinophils of these patients and also in cells from other patients with marked eosinophilia; and (4) echocardiography may prove to be a useful noninvasive tool to diagnose and follow the progress of cardiac involvement. Although none of these patients was thought to have leukemia, intensive therapy with steroids or cytotoxic agents, or both, is considered necessary to control the progression of the disease.

Topics: Adolescent; Adult; Busulfan; Cardiomyopathies; Cytoplasmic Granules; Digoxin; Diphenhydramine; Eosinophilia; Eosinophils; Female; Furosemide; Hepatomegaly; Humans; Hydroxyurea; Male; Middle Aged; Prednisone; Splenomegaly; Syndrome

Digoxin, in a common clinical dose and at a low serum level, brought out severe manifestations of sinus node dysfunction in a patient who had previously undergone successful mitral valve replacement. This report presents the results of extensive clinical and electrophysiologic studies of this patient before and after a digoxin challenge. In the absence of cardiac glycoside, the only demonstrable abnormalities of sinus node function were mild resting sinus bradycardia and failure to respond to atropine administration. Responses to isoproterenol administration, programmed premature atrial stimulation, and overdrive pacing at several cycle lengths were normal. Following the administration of intravenous digoxin, 1.025 mg/24 hrs, the resting sinus cycle length increased and the response to overdrive pacing became markedly abnormal. The latter was followed by sinus pauses in excess of six seconds, even at relatively slow overdrive pacing rates. The electrophysiologic and clinical implications of these data are discussed. It is suggested that despite previous reports that digitalis preparations are relatively well tolerated by patients with sick sinus syndrome, caution should be used when administering these drugs to this group of patients.

Topics: Arrhythmia, Sinus; Atrioventricular Node; Atropine; Bradycardia; Digoxin; Electrocardiography; Heart Conduction System; Heart Failure; Heart Rate; Humans; Isoproterenol; Male; Middle Aged; Sinoatrial Node; Syndrome; Tachycardia

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Injections, Intravenous; Male; Methyldopa; Middle Aged; Syndrome; Tachycardia; Tachycardia, Paroxysmal; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Autoimmune Diseases; Betamethasone; Dexamethasone; Digoxin; Humans; Myocardial Infarction; Radiography, Thoracic; Syndrome; Warfarin