digoxin and Ventricular-Dysfunction

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Cardiac Resynchronization Therapy; Defibrillators, Implantable; Digoxin; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Sodium Potassium Chloride Symporter Inhibitors; Stroke Volume; Ventricular Dysfunction

Heart failure is becoming the most prevalent cardiovascular disorder in the older population, in part as a consequence of the declining fatality rate of hypertension, myocardial infarction and ictus, resulting in progressive increment of older subjects at increased risk of developing heart failure. In this review the principal aspects of congestive heart failure in the elderly are described, underlining the necessity of distinguish the "normal" ageing process from the many noxae that cause this disease. Moreover a discussion is given about the peculiarity of the physiopathology and symptomatology of heart failure in the aged patients, with particular emphasis to the diastolic ventricular dysfunction that is very frequent in these patients, posing complex problems of diagnosis and therapy.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Calcium Channel Blockers; Cardiotonic Agents; Clinical Trials as Topic; Diastole; Digoxin; Diuretics; Drug Interactions; Echocardiography; Electrocardiography; Fibrinolytic Agents; Heart Failure; Humans; Platelet Aggregation Inhibitors; Radiography, Thoracic; Systole; Ventricular Dysfunction

Topics: Acute Disease; Aged; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Systole; Tachycardia; Ventricular Dysfunction

Fetal tachycardia complicated by ventricular dysfunction and hydrops fetalis carries a significant risk of morbidity and mortality. Transplacental digoxin is effective therapy in a small percentage, but there is no consensus with regard to antiarrhythmic treatment if digoxin fails. This study evaluates the safety, efficacy, and outcome of amiodarone therapy for digoxin-refractory fetal tachycardia with heart failure.. Fetuses with incessant tachycardia and either hydrops fetalis (n=24) or ventricular dysfunction (n=2) for whom digoxin monotherapy and secondary antiarrhythmic agents (n=13) were not effective were treated transplacentally with a loading dose of oral amiodarone for 2 to 7 days, followed by daily maintenance therapy for <1 to 15 weeks. Digoxin therapy was continued throughout gestation. Newborns were studied by transesophageal pacing or ECG monitoring to determine the mechanism of tachycardia. Three fetuses were delivered urgently in tachycardia during amiodarone loading, and 3 required additional antiarrhythmic agents for sustained cardioversion. Amiodarone or amiodarone combinations converted 14 of 15 (93%) with reentrant supraventricular tachycardia, 2 of 2 with ventricular or junctional ectopic tachycardia, and 3 of 9 (33%) with atrial flutter. Amiodarone-related adverse effects were transient in 5 infants and 8 mothers. Mean gestational age at delivery was 37 weeks, with 100% survival.. Orally administered amiodarone is safe and effective treatment for drug-refractory fetal tachycardia, specifically reentrant supraventricular tachycardia, junctional ectopic, or ventricular tachycardia, even when accompanied by hydrops fetalis or ventricular dysfunction.

Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Electrocardiography; Female; Fetal Diseases; Humans; Hydrops Fetalis; Male; Pregnancy; Tachycardia; Treatment Failure; Treatment Outcome; Ventricular Dysfunction

Congestive heart failure was diagnosed in a 27-year-old Indian ringneck parakeet with exercise-induced dyspnea. A grade IV/VI holosystolic murmur that radiated to the right sternal area was auscultated over the left side of the sternum. Radiography revealed progressive cardiomegaly, hepatomegaly, pulmonary edema, and accumulation of fluid within the coelomic cavity. Echocardiography revealed biatrial enlargement and enlargement of the right ventricle. Doppler recording revealed high velocity left and right atrioventricular valve regurgitation. Treatment with digoxin and furosemide alleviated clinical signs for approximately 10 months. Gross postmortem examination revealed cardiac enlargement and eccentric hypertrophy of both ventricles on cross-section. Pulmonary congestion and edema, hepatomegaly, hepatic congestion, and ascites were also evident. Histologic examination of the heart revealed myxomatous degeneration of the left atrioventricular valve, muscular hypertrophy of the right atrioventricular valve, and biventricular chronic myofiber degeneration and necrosis.

Topics: Animals; Bird Diseases; Digoxin; Diuretics; Echocardiography, Doppler, Color; Electrocardiography; Fatal Outcome; Furosemide; Heart Auscultation; Heart Failure; Heart Valve Diseases; Parakeets; Radiography, Thoracic; Ventricular Dysfunction

To study the etiology, precipitating factors, clinic features, patterns of ventricular disfunction, treatment, hospital length of stay and mortality of patients admitted to hospital because of heart failure.. It's a prospective study of 305 patients with heart failure admitted consecutively in a short stay unit.. The mean age was 73.6 +/- 10.8 years. 50.5% were women and 49.5% men. Women (76.5 +/- 9.7 years) were older than men (70.5 +/- 11.0 years). The etiology was valvular heart disease 30.8%, hypertensive heart disease 26.2%, ischemic heart disease 21.6%, idiopathic dilated cardiomyopathy 8.2% and alcoholic cardiomyopathy 5.6%. The more frequent precipitating factors were respiratory infection (37.3%) and arrhythmias (28.7%). No precipitating factor was detected in 13.9%. 46.1% had systolic disfunction (erection fraction < 50%). 96.7% were treated with diuretics, 79.3% with ACE inhibitors and 51.9% with digoxin. 5.3% needed cardiac surgery. Mean length of stay was 5.64 days. In hospital mortality was 5.6%.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Digoxin; Diuretics; Echocardiography; Electrocardiography; Female; Heart Failure; Humans; Length of Stay; Male; Middle Aged; Prospective Studies; Risk Factors; Time Factors; Ventricular Dysfunction

It is not known whether quality of care for congestive heart failure (CHF) at rural hospitals is similar to that in larger, urban hospitals.. We reviewed hospital charts for 310 Medicare patients hospitalized with CHF at six hospitals in rural Georgia.. Of the 310 patients, 101 (33%) had left ventricular systolic dysfunction, and 60 (19%) had preserved systolic function. Information on left ventricular function was not available for 48% (range, 29% to 87% across the six hospitals). Among patients with systolic dysfunction, 77% were prescribed an angiotensin converting enzyme (ACE) inhibitor at discharge, and 73% were prescribed digoxin. However, the mean daily ACE inhibitor dose was only 48% of the recommended target dose. Only 30% of all patients with atrial fibrillation were prescribed warfarin.. Overall quality of care for CHF at rural hospitals appears similar to that in other settings, though many patients may not receive evaluation of ventricular function.

Topics: Aged; Algorithms; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiotonic Agents; Digoxin; Drug Utilization; Female; Georgia; Heart Failure; Hospitals, Rural; Humans; Male; Medical Records; Medicare; Quality of Health Care; Retrospective Studies; United States; Ventricular Dysfunction; Warfarin

The mechanisms of digoxin-induced ventricular arrhythmias were studied in vivo using a novel experimental model. Anesthetized guinea pigs were instrumented with custom-made electrode catheters which enabled the monitoring and recording of right atrial, right ventricular, and His bundle electrograms, midmyocardial monophasic action potentials (MAP), and systemic arterial blood pressure. Intravenous digoxin induced ventricular arrhythmias ranging from ventricular premature contractions (VPCs) to ventricular fibrillation (VF). These were associated with delayed afterdepolarizations (DADs) observed on the MAP recordings. The severity of the arrhythmias depended on the dose of digoxin. Short bursts of ventricular pacing neither terminated nor suppressed episodes of ventricular tachycardias (VTs). A direct relationship existed between the paced ventricular cycle length and the coupling interval between the last paced beat and the first ectopic beat (r = 0.913, P < 0.001, n = 10) and between the amplitude of the DADs and the pacing rate (r = 0.972, P < 0.05, n = 7). The increased contractility (LV dp/dt) and heart rate evoked by isoproterenol (0.1 microgram/kg) did not induce DADs in the absence of digoxin. Verapamil terminated the digoxin-induced VTs in 15 of 16 animals and abolished the associated DADs in 7 of 7 animals. Adenosine terminated the VTs in 15 of 19 animals and abolished the DADs in 8 of 10 animals. Digoxin induced VT in only 1 of 6 animals treated with reserpine (5 + 5 mg/kg) 24 and 48h prior to experimentation. However, subsequent intravenous isoproterenol (0.2 micrograms/kg) induced VT and DADs, both of which were abolished by verapamil, in all 6 animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine; Analysis of Variance; Animals; Arrhythmias, Cardiac; Catecholamines; Digoxin; Disease Models, Animal; Electrocardiography; Female; Guinea Pigs; Male; Propranolol; Random Allocation; Reserpine; Ventricular Dysfunction; Verapamil

Heart failure is today one of the most serious health problems of modern industrialized societies. The increase in the mean age of the population is an additional factor which favours a high incidence of episodes of heart failure. Age is also a relevant factor in mortality linked with heart failure. On this basis more emphasis has been given by researchers and physicians to improve a preventive and therapeutic approach to heart failure. For many years the pharmacological treatment of heart failure patients was based on the increase in inotropism through the digitalis and on the reduction in sodium-water retention through diuretics, while less importance was given to the improvement of the afterload. We have had knowledge of vasodilatory drugs in chronic heart failure for at least 20 years but only 10 years ago with the Vasodilator-Heart Failure Trial (V-HeFTI), it was proved that the combination of hydralazine and nitrates in addition to the conventional treatment, improved the survival of patients affected by moderate-severe heart failure. With the advent of the ACE-inhibitors, in the '80s, the first studies concerning the role of such drugs in heart failure were carried out. In the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS I) it was proved for the first time that an ACE-inhibitor (enalapril), added to the conventional heart failure therapy, improved the survival of patients with severe congestive heart failure (NYHA class IV). The result was so extraordinary that the study was interrupted for ethical reasons. However, it has raised a considerable interest in the study of the ACE-inhibitors in heart failure and now it has been proved that such drugs are a milestone in a correct pharmacological approach to heart failure.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Angiotensin-Converting Enzyme Inhibitors; Clinical Trials as Topic; Clinical Trials, Phase I as Topic; Digoxin; Drug Therapy, Combination; Enalapril; Felodipine; Follow-Up Studies; Heart Failure; Humans; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Randomized Controlled Trials as Topic; Time Factors; Vasodilator Agents; Ventricular Dysfunction