digoxin and Thromboembolism

Topics: Adrenergic beta-Antagonists; Anticoagulants; Atrial Fibrillation; Catheter Ablation; Digoxin; Humans; Incidence; Kidney Failure, Chronic; Randomized Controlled Trials as Topic; Renal Dialysis; Risk Factors; Stroke; Thromboembolism

The incidence of cardiac arrhythmias is estimated et 1.2 per 1000 pregnancies, usually in the third trimester and 50% of them are asymptomatic. They may appear for the first time in pregnancy or have a recurring character An important risk factor related to their appearance is the presence of structural heart disease, which complicates < 1% of pregnancies. Generally the symptoms are mild and the treatment is not necessary but in some cases pharmacotherapy is necessary Pharmacotherapy must be a compromise between the potentially adverse effects of drugs on the fetus and the beneficial effects on the cardiovascular system of the mother. Due to the development of cardiac surgery many women with heart defects reach reproductive age and become pregnant. Therefore this problem will be faced more and more often in clinical practice. In addition to pharmacological methods some cardiac arrhythmias may require urgent, life-saving procedures. External electrical cardioversion is associated with the application of certain amount of energy via two electrodes placed on the thorax. It is used to treat hemodynamically unstable supraventricular tachycardias, including atrial fibrillation and atrial flutter Also in hemodynamically stable patients in whom drug therapy was ineffective elective electrical cardioversion can be use to convert cardiac arrhythmia to sinus rhythm. We present a case of a 33 years old patient with congenital heart disease surgically corrected in childhood who had first incident of atrial flutter in pregnancy. Arrhytmia occured in 26th week of gestation. The patient was hemodynamically stable and did not approve electrical cardioversion as a method of treatment therefore pharmacotherapy was started. Heart rate was controled with metoprolol and digoxin, warfarin was used to anticoagulation. Calcium and potassium were also given. Described therapy did not convert atrial flutter to sinus rhythm therefore in 33rd week of gestation after patient's approval electrical cardioversion was performed. Before cardioversion transesophageal echocardiogram was made to exclude the presence of thrombus inside atria. Energy of 50J was applied and sinus rhythm was restored. Cardiotocography during and after cardioversion did not show any significant fetal heart rate changes. Further pregnancy and puerperium were uneventful. Case report and review of the literature about cardiac arrhytmias and methods of its treatment especially in pregnant women. Analysis of medical do

Topics: Adult; Anti-Arrhythmia Agents; Anticoagulants; Arrhythmias, Cardiac; Digoxin; Electric Countershock; Female; Heart Rate, Fetal; Humans; Metoprolol; Pregnancy; Pregnancy Complications, Cardiovascular; Thromboembolism; Warfarin

Atrial fibrillation is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of atrial mechanical function. It is a common arrhythmia that presents various treatment options. Pharmacologic therapy is used to maintain sinus rhythm, to control the ventricular response, or to convert atrial fibrillation to sinus rhythm and prevention of thromboembolism. Cardioversion shocks are applied through surface or intrathoracic electrodes to convert atrial fibrillation to sinus rhythm. The tendency for recurrence of atrial fibrillation is high. Treatment with antiarrhythmic drugs has decreased its recurrence. Drugs that slow conduction through the AV node (such as digoxin, beta blockers and calcium channel blockers) have been used as adjuvants to therapy for the prevention of atrial fibrillation. Drugs used for the prevention of atrial fibrillation are antiarrhythmic drugs of class IA and C, and type III. Drug combination acting through different electrophysiological channels and mechanisms may prove beneficial in the prevention of atrial fibrillation.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Digoxin; Humans; Secondary Prevention; Thromboembolism

Topics: Acute Disease; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Diltiazem; Electrocardiography; Fibrinolytic Agents; Humans; Prognosis; Randomized Controlled Trials as Topic; Thromboembolism; Timolol; Treatment Outcome; Verapamil

Atrial fibrillation (AF) is the commonest arrhythmia. It presents in distinct patterns of paroxysmal, persistent and chronic AF, and patient management aims differ according to the pattern. In paroxysmal AF, drug treatment with beta-blockers, class Ic and class III agents reduce the frequency and duration of episodes. In persistent AF (recent onset, non-paroxysmal), early cardioversion with either pharmacological agents or by direct current (DC) cardioversion should be actively considered, in those patients who are suitable. Patients most likely to cardiovert and remain in sinus rhythm include those with duration of AF of <1 year, an acute reversible cause, left atrial diameter <50 mm and good left ventricular function on echocardiography. Recent data show that maintenance of sinus rhythm after successful cardioversion is enhanced by the use of class III drugs including amiodarone and dofetilide. In chronic or permanent AF, management is aimed at controlling the ventricular rate response with combinations of digoxin, beta-blockers and calcium antagonists with atrio-ventricular nodal activity (diltiazem and verapamil). There is some debate about the prognostic significance of AF. Certainly AF is associated with an excess mortality but this is largely accounted for by its association with serious intrinsic heart disease and the thrombo-embolic complications of the arrhythmia. Atrial fibrillation is a common default arrhythmia for the sick heart.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Cardiovascular Surgical Procedures; Digoxin; Echocardiography; Electric Countershock; Humans; Postoperative Complications; Prognosis; Risk Factors; Thromboembolism

Because of its prevalence in the population and its associated underlying diseases and morbidity, atrial fibrillation (AF) is an important and costly health problem. Advancing age, diabetes, heart failure, valvular disease, hypertension, and myocardial infarction predict the occurrence of AF within a population. The management of AF is complex and involves prevention of thromboembolic complications and treatment of arrhythmia-related symptoms. Stroke occurs in 4.5% of untreated patients with AF per year. Independent risk factors for stroke in nonrheumatic patients with AF are advanced age; a history of prior embolism, hypertension, or diabetes; and echocardiographic findings of left atrial enlargement and left ventricular dysfunction. Warfarin decreases stroke by two-thirds and death by one-third; aspirin is only about half as effective overall and is insufficient therapy for those with risk factors for stroke. Options for thromboembolic prophylaxis are use of warfarin for all in whom it is safe or, alternatively, warfarin for those with risk factors and aspirin for those without risk factors. One-half of the patients with AF are 75 years of age or older. The uniform applicability and relative safety of warfarin therapy in this age-group are controversial. Specific therapy for the arrhythmia should be dictated by the need to control symptoms. Symptomatic treatments include rate-control medications and strategies designed to terminate and prevent arrhythmia recurrence. Digoxin, beta-adrenergic blockers, verapamil, and diltiazem slow excessive ventricular rates in patients with AF and may favorably manage comorbid conditions. The efficacy of anti-arrhythmic medications is only 40 to 70% per year in preventing recurrences of AF, and these agents, except amiodarone, may increase the risk of sudden death in patients with certain types of organic heart disease and AF. The use of nonpharmacologic symptomatic therapies such as atrioventricular node modification or ablation with a rate-response pacemaker or surgical intervention is increasing.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Aged; Anti-Arrhythmia Agents; Aspirin; Atrial Fibrillation; Catheter Ablation; Cerebrovascular Disorders; Diabetes Complications; Digoxin; Diltiazem; Embolism; Humans; Hypertension; Thromboembolism; Verapamil; Warfarin

Atrial fibrillation represents a common and challenging arrhythmia. A rational approach to management of the individual case depends on careful assessment of the temporal of the arrhythmia, any associated cardiovascular disease, and any particular features suggesting the advisability or risks of any particular treatment regimen. The nature of an arrhythmia and of individual patient factors change over time, requiring a flexible approach to long-term treatment that may be defined only after months or years. While new treatment options such as catheter ablation techniques and implantable atrial defibrillators are being tested, old therapies (e.g., low-dose amiodarone) are undergoing reappraisal. Increasing recognition of the dangers of antiarrhythmic therapy used to maintain sinus rhythm is focusing attention on nonpharmacologic methods. All patients with persistent atrial fibrillation merit serious consideration for direct current cardioversion before accepting that atrial fibrillation is permanent, and many patients may benefit from more than one attempt to restore and maintain sinus rhythm.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Calcium Channel Blockers; Catheter Ablation; Digoxin; Electric Countershock; Flecainide; Heart Failure; Heart Rate; Heart Ventricles; Humans; Quinidine; Sinoatrial Node; Thromboembolism; Time Factors

Topics: Animals; Cardiomyopathies; Cat Diseases; Cats; Diet, Sodium-Restricted; Digoxin; Electrocardiography; Furosemide; Heart Diseases; Heart Failure; Lidocaine; Propranolol; Thromboembolism

The VERDICT (Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion Trial) is a prospective, randomized study to investigate whether: 1) acutely repeated serial electrical cardioversions (ECVs) after a relapse of atrial fibrillation (AF); and 2) prevention of intracellular calcium overload by verapamil, decrease intractability of AF.. Rhythm control is desirable in patients suffering from symptomatic AF.. A total of 144 patients with persistent AF were included. Seventy-four (51%) patients were randomized to the acute (within 24 h) and 70 (49%) patients to the routine serial ECVs, and 74 (51%) patients to verapamil and 70 (49%) patients to digoxin for rate control before ECV and continued during follow-up (2 x 2 factorial design). Class III antiarrhythmic drugs were used after a relapse of AF. Follow-up was 18 months.. At baseline, there were no significant differences between the groups, except for beta-blocker use in the verapamil versus digoxin group (38% vs. 60%, respectively, p = 0.01). At follow-up, no difference in the occurrence of permanent AF between the acute and the routine cardioversion groups was observed (32% [95% confidence intervals (CI)] 22 to 44) vs. 31% [95% CI 21 to 44], respectively, p = NS), and also no difference between the verapamil- and the digoxin-randomized patients (28% [95% CI 19 to 40] vs. 36% [95% CI 25 to 48] respectively, p = NS). Multivariate Cox regression analysis revealed that lone digoxin use was the only significant predictor of failure of rhythm control treatment (hazard ratio 2.2 [95% CI 1.1 to 4.4], p = 0.02).. An acute serial cardioversion strategy does not improve long-term rhythm control in comparison with a routine serial cardioversion strategy. Furthermore, verapamil has no beneficial effect in a serial cardioversion strategy.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium; Digoxin; Electric Countershock; Female; Hemorrhage; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Recurrence; Thromboembolism; Treatment Outcome; Verapamil

This study aimed to reveal the incidence of clinical endpoints in elderly patients with atrial fibrillation (AF) during a 2-year follow-up and evaluate the related prognostic factors of these endpoints.In total, 200 elderly patients with AF and 400 age- and sex-matched patients without AF were enrolled in this prospective observational cohort study. The incidence of clinical endpoints, including thromboembolism, hemorrhage, and all-cause death, during the 2-year follow-up was analyzed. Other follow-up data, including disease history, laboratory examinations, medication status, and other clinical endpoints, were collected. The prognostic factors of these clinical endpoints were then evaluated by Cox-survival analysis. In addition, the predicative role of C-reactive protein (CRP) and platelet-activating factor (PAF) on these clinical endpoints was analyzed.The incidence of clinical endpoints, including thromboembolism, hemorrhage, and all-cause death, was significantly higher in patients with AF than in those without AF (27.8% vs 9.8%, 29.4% vs 12.7%, and 28.7% vs 11.6%, respectively; all P < .001). Antithrombotic therapy significantly reduced the incidences of all-cause deaths (P < .05). Body mass index (BMI) and digoxin were prognostic risk factors of thromboembolism; age, massive hemorrhage history, and digoxin were prognostic risk factors of hemorrhage and age, renal insufficiency history, massive hemorrhage history, and digoxin were prognostic risk factors of all-cause death (P < .05). Further, both CRP and PAF were prognostic risk factors of thromboembolism and massive hemorrhage (P < .05).Age, BMI, massive hemorrhage history, and digoxin appear to be prognostic risk factors of clinical endpoints in elderly patients with AF. Appropriate drug use during follow-up may be beneficial in preventing the occurrence of clinical endpoints in elderly patients with AF.. ChiCTR-OCH-13003479.

Topics: Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Body Mass Index; C-Reactive Protein; Case-Control Studies; China; Digoxin; Female; Fibrinolytic Agents; Follow-Up Studies; Hemorrhage; Humans; Male; Platelet Activating Factor; Prognosis; Proportional Hazards Models; Prospective Studies; Thromboembolism

Atrial fibrillation (AF) is a common comorbid condition in patients admitted to hospital. In managing patients with AF, recent research has highlighted the importance of heart rate control, cardioversion, maintenance of sinus rhythm and anticoagulation for the prevention of thromboembolism.. To determine the prevalence of AF in patients admitted acutely to the general medical service at Auckland Hospital and to assess the adequacy of heart rate control, the number cardioverted and the use of warfarin to prevent thromboembolism.. Prospective review of all acute admissions to the general medical service over a 12 week period. Information was collected from hospital notes on the patients' present and past medical conditions, admission and discharge cardiac medication and the use of investigations, particularly thyroid function tests and echocardiography. The heart rate on discharge, number cardioverted either during the admission or after discharge and the number given warfarin and aspirin were recorded.. One hundred and forty-seven patients (aged 38-96, mean age 76 years and 52% male) were admitted in AF 165 times out of the 1637 admissions over the study period (a prevalence of 10.4%, 95% CI 8.6-11.5%). The main causes of admission were heart failure (23%), pneumonia or sepsis (17%), cerebrovascular accident (CVA) or transient ischaemic attack (TIA) (14%) and ischaemic heart disease (11%). Past medical history included hypertension (46%), ischaemic heart disease (39%), congestive heart failure (58%), valvular heart disease (12%), chronic obstructive airways disease (24%), CVA, TIA or thromboembolic event (24%) and diabetes (17%). Thyroid function tests were performed in 50% of patients and echocardiograms in 38%. Heart rate control at discharge could not be assessed, as this was not recorded prior to any patient's discharge. Seventy-eight per cent of patients were discharged on digoxin but only 29% on drugs that control the heart rate with exercise. Five patients out of 11 considered for cardioversion had a successful cardioversion in hospital and two were later cardioverted as outpatients. Twenty-eight per cent were discharged on warfarin, 33% on aspirin and one patient on both. Fifty-two per cent were considered to have contraindications to warfarin therapy. Prescribing rates for warfarin did not vary according to the patients' clinical risk for thromboembolism.. AF is a common comorbid condition in the acute general medical ward. Standard investigations were under-utilised. Attention needs to be paid to the recording and control of heart rate at rest and on exercise. Cardioversion is considered infrequently. This patient group had a high risk for thromboembolism and after excluding the large group in whom warfarin was contraindicated, warfarin was still under-utilised.

Topics: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Anticoagulants; Aspirin; Atrial Fibrillation; Digoxin; Electric Countershock; Female; Humans; Male; Middle Aged; New Zealand; Patient Admission; Platelet Aggregation Inhibitors; Prospective Studies; Thromboembolism; Warfarin

Atrial fibrillation is a very common arrhythmia and frequently seen by general practitioners. Its rational management entails careful consideration of the goals of therapy. These differ from patient to patient and may include control of ventricular rate, conversion to and maintenance of sinus rhythm and prophylaxis against thromboembolism. This article will focus on the various therapeutic agents available for achieving these aims and will attempt to provide some guidance through what has become a confusing maze of potential therapeutic strategies.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Heart Conduction System; Humans; Thromboembolism

This survey deals with the 5 most important internal problems of old aged people undergoing surgery: chronic emphysematous bronchitis, geriatric heart, Diabetes mellitus, bleeding tendency during operation and venous thromboembolism.

Topics: Aged; Bandages; Blood Coagulation Disorders; Bronchitis; Diabetes Mellitus; Digitoxin; Digoxin; Emphysema; Exercise Therapy; Heart Failure; Humans; Hypoglycemic Agents; Preoperative Care; Respiratory Therapy; Strophanthins; Thromboembolism

Topics: Aged; Anesthesia; Anesthesia, Conduction; Anesthesia, General; Anesthetics; Cardiovascular Diseases; Cardiovascular Physiological Phenomena; Coronary Disease; Digoxin; Emergencies; Geriatrics; Homeostasis; Humans; Kidney; Liver; Metabolism; Nerve Block; Postoperative Care; Postoperative Complications; Preoperative Care; Respiratory Physiological Phenomena; Respiratory Therapy; Respiratory Tract Diseases; Surgical Procedures, Operative; Thromboembolism

A 56-year-old male patient diagnosed as a case of procainamide-induced systemic lupus erythematosus (SLE) was found to have a lymphoproliferative disorder at postmortem examination.Contrary to other immune disorders, the association of SLE with neoplasia is a rare occurrence. The present case raises the question of whether a relationship exists between the lupus diathesis and lymphoreticular neoplasia. The study of the incidence of neoplasia in families of patients with SLE may prove helpful in establishing this relationship.

Topics: Aortic Diseases; Autopsy; Blindness; Bone Marrow; Digoxin; Drug Therapy, Combination; Heart Diseases; Heparin; Humans; Immunologic Deficiency Syndromes; Kidney; Lupus Erythematosus, Systemic; Lymph Nodes; Lymphoma; Male; Middle Aged; Procainamide; Quinidine; Retinal Artery; Spleen; Thromboembolism; Warfarin

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