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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the value of a multivariate approach for the analysis of the treadmill exercise tolerance test (ETT), 237 patients referred for evaluation of chest pain who underwent a standard Bruce protocol ETT and coronary arteriography were studied. Predictive value of a positive ETT was 0.78 (43/55) using 1.0--1.9 mm ST segment depression criterion, 0.97 (59/61) using greater than or equal to 2.0 mm ST segment depression. When the 1.0--1.9 mm ST criterion was combined with peak systolic blood pressure-heart rate product (double product) less than or smaller than 23,000, exercise duration less than 6 minutes, and ST depression for greater than 3 minutes into recovery, predictive value improved to 0.89 in 18 patients with any two of the above. Predictive value for multivessel disease was also improved using non-ST criteria. Predictive value of a negative ETT for absence of coronary artery disease was 0.60 (29/48), and was 0.86 (12/14) if double product was greater than or equal to 30,000. Presence of chest pain during ETT did not improve predictive value of any type of test. Digitalis ingestion in 33 patients was not associated with decreased predictive value of a positive test. These data suggest that the predictive value of both positive and negative ETT in a symptomatic population can be improved with a multivariate approach.
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PMID:A multivariate approach for interpreting treadmill exercise tests in coronary artery disease. 67 42

The present investigation was designed to study the relationship between mechanical and electrophysiological actions on the heart of digitalis and the effects on it of K administration. Nineteen anesthetized dogs were given acetylstrophanthidin (AS) (30 gamma/Kg, followed by 1 gamma/Kg/min. When ectopic tachycardia occurred, sinus rhythm was restored with an infusion of K (5 mEq/Kg/hour, for 5 min). As the dose of AS was increased beyond 30 approximately 40 gamma/Kg, ventricular rate during electrically induced atrial fibrillation was reduced and PQ interval prolonged, while PP interval, QT interval and QRS duration showed little changes. Ectopic tachycardia occurred at an average dose of 56.9 gamma/Kg of AS. The indices of mechanical properties, dp/dt/IIT, max dp/dt and dp/dt (50), began to increase as soon as AS infusion was started and continued to increase during the administration of AS. The dp/dt (50) and PP interval or ventricular rate during atrial fibrillation did not change in parallel. Inotropic activity was not depressed even during ectopic tachycardia. The administration of K eliminated ectopic tachycardia, but caused no changes in the other electrophysiological and mechanical properties of the digitalized heart. The following conclusions were derived from the experiment. 1) The 2 actions of digitalis, mechanical and electrophysiological ones, are not necessarily related to each other. 2) Digitalis intoxication, represented by ectopic tachycardia, does not mean the depression of the inotropic activity. 3) The administration of K does not affect the inotropic activity of digitalis.
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PMID:Correlation of the electrophysiological and mechanical changes in the dog heart during digitalis administration, and the effect of potassium on it. 118 92

Depression is frequently seen in patients following myocardial infarction (MI), many of whom are receiving digitalis glycosides, beta-blockers, or other agents that may exert central nervous system (CNS) effects. In a prospective study of the clinical significance of post-MI depression, 335 patients were assessed using a standardized diagnostic interview for depression at 8 to 10 days, and 190 were reinterviewed at 3 to 4 months. Patients prescribed digitalis, beta-blockers, or other cardioactive medications at hospital discharge were identified. Logistic regression analyses were performed to determine the contribution of these agents to depression at 3 to 4 months, controlling for medical and sociodemographic factors as well as for baseline depression. Treatment with digitalis predicted depression at 3 to 4 months (p less than 0.05); no other medications, including beta-blockers, predicted depression (p greater than 0.10). Digitalis may have CNS effects that contribute to depression post-MI and this finding should be considered in the differential diagnosis of depression in cardiac patients.
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PMID:Digitalis and beta-blocking agents: effects on depression following myocardial infarction. 167 83

Exercise-induced changes in the ST segments of the electrocardiogram were compared with the results of coronary arteriography in 73 consecutive patients referred for preoperative evaluation of coronary artery disease. Eighteen patients had single-, 25 double-, and 30 triple-vessel disease. Thirteen were taking digitalis alone, 28 were taking beta blockers alone, 21 had beta blockers and digitalis and 11 had no cardiac drugs. Exercise induced elevation of the ST segment in 11 patients, all with a predominant lesion in the left anterior descending coronary artery. ST depression with an upsloping ST segment was observed in patients with one-, two-, and three-vessel disease and it was the most common type of ST change in patients with single-vessel disease. Horizontal ST depression was most common in two-vessel disease and downsloping ST segment in three-vessel disease. There was a good correlation between the number of stenosed vessels and ST changes caused by exercise, expressed as the sum of ST segment displacements in twelve leads recorded immediately after the end of exercise (sigma/ST/) or as ST depression per unit increase in heart rate during exercise ("m" (ST/HR]. The latter was obtained by linear regression of ST displacement and heart rate measured at three or four different workloads in the lead with the greatest displacement of the ST segment. The mean values of sigma/ST/ were 0.58 +- 0.030 mV in single-vessel, 0.97 +- 0.41 mV in double-vessel and 1.58 +- 0. 46 mV in triple-vessel disease. The mean values of "m" (ST/HR) were 0.0024 +- 0.0013 mV X min-1 X beat-1 in single-vessel, 0.0042 +- 0.0012 in double-vessel, and 0.0078 +- 0.0033 in triple-vessel disease. These differences were highly significant (p less than 0.01 - 0.001) and there was only minimal overlap between the single- and triple-vessel groups. Digitalis caused a slight (statistically nonsignificant) increase in sigma/ST/ but not in "m" (ST/HR).
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PMID:Qualitative and quantitative evaluation of the exercise electrocardiogram in assessing the degree of coronary heart disease. 285 60

Digitalis intoxication is characterized by the appearance of most of the types of severe arrhythmias described and also by important disturbances of cardiac excitability and impulse propagation. Most of the antiarrhythmic agents that are used in the treatment of these conditions also depress excitability and impulse propagation. These characteristics are frequently responsible of severe complications. The purpose of this paper is to determine the type of interactions that exist between digitalis and some antiarrhythmic agents, and compare them with the effects of magnesium. The experiments were done in several groups, of dogs anesthetized with pentobarbital and with the chest open. Excitability, conduction time and functional refractory period were determined using the classical methods. The protocol used consisted in the comparison of the actions of toxic doses of digitalis on excitability and conduction times of the atrial and ventricular tissues, under control conditions and in the presence of therapeutic doses of procainamide, lidocaine and magnesium. The results showed that procainamide worsened the depression of excitability and conduction produced by digitalis intoxication, while lidocaine does not add to the digitalis effects and in some cases it produces a partial improvement of these parameters. Magnesium completely reverts the effects on excitability and conduction. These results provide us with rational pharmacological bases for the treatment of digitalis intoxication and suggest that magnesium could be very useful in the management of patients with severe digitalis intoxication.
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PMID:[Effects of several anti-arrhythmia agents on excitability and conduction depressed by digitalis agents]. 624 58

This is a report of a case of the hypereosinophilic syndrome associated with extensive asynergy of the left ventricular wall. This 41-year-old man's hospital admission in March, 1982 was for congestive heart failure, with marked eosinophilia (34%). Slight depression of the ST segments and flatness of the T waves were observed in electrocardiographic leads I, II, III, a VF, and V 5-6. Digitalis and diuretics were ineffective, but supplementary prednisone therapy resulted in a decrease in eosinophilia and improvement of congestive heart failure. He was transferred to our hospital for further examination in May, 1982. There were no signs of congestive heart failure, but a third heart sound was detected on admission. Marked ST segment depression and inverted T waves were observed in the left precordial leads. Echocardiography cardiography showed extensive asynergy of the left ventricular wall, and progressive enlargement of the left atrium and left ventricle. High density area near the apex of the left ventricle suggested the presence of mural thrombi. A left endocardial biopsy showed organized thrombi sparsely invaded by eosinophils. There were no signs nor symptoms of peripheral emboli. Tapering of the dose of prednisone was attempted twice, but each time eosinophilia resulted. The patient is now free of symptoms, and is being maintained on 25 mg of prednisone daily.
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PMID:[Hypereosinophilic syndrome associated with extensive asynergy of the left ventricular wall: a case report]. 653 89

The prevalence of atrial fibrillation increases with age, with rates of 2-5% among people over the age of 60 years. Patients may be highly symptomatic or may suffer from hemodynamic compromise or thromboembolic complications. However, antiarrhythmic drug treatment implies problems like the choice of the suitable drug, the individual benefit/risk profile, and alternative treatment strategies. Experimental and clinical data support the concept that atrial fibrillation in the clinical setting in most cases is due to multiple reentrant wavelets. A critical number of three to six simultaneously circulating reentrant wavelets seems to be necessary for the maintenance of atrial fibrillation. Consequently, antiarrhythmic drugs may terminate or prevent atrial fibrillation by prolonging the refractory period or slowing conduction velocity, thereby leading to conduction block. In clinical practice, antiarrhythmic therapy may act by slowing of the ventricular rate due to depression of atrioventricular nodal conduction or by termination and/or prevention of atrial fibrillation. Digitalis is commonly used for the control of the ventricular rate. Betablocking drugs and verapamil are effective in this respect during exercise performance. For antiarrhythmic conversion and prophylaxis of recurrences of atrial fibrillation, class Ia (e.g., quinidine), Ic (e.g., flecainide and propafenone), and class III (e.g., amiodarone and sotalol) drugs of the Vaughan Williams classification are useful. Presently, no general concept exists whether medical or electrical cardioversion should be used as a first line approach for termination of atrial fibrillation. In the individual patient with atrial fibrillation, the potential benefit of restoring sinus rhythm must be weighed against the morbidity and mortality of the arrhythmia and the morbidity and mortality of the antiarrhythmic agents used.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Problems with anti-arrhythmia therapy in atrial fibrillation]. 784 47

Digitalis-like compounds are recently identified steroids synthesized by the adrenal gland, which resemble the structure of plant cardiac glycosides. These compounds, like the plant steroids, bind to and inhibit the activity of the Na+, K+-ATPase. The possible function of the endogenous digitalis-like compounds has to be evaluated in view of the presence of different isoforms of the Na+, K+-ATPase, which differ in their sensitivity to digitalis. This review focuses on recent published data on the Na+, K+-ATPase inhibitors, the digitalis-like compounds, regarding their structure, biosynthesis and secretion from the adrenal gland, physiological role and pathological implications in diseases such as hypertension and depression. Emphasis is given to studies describing the involvement of these compounds in brain function.
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PMID:Endogenous digitalis-like Na+, K+-ATPase inhibitors, and brain function. 1169 49

Depression is common in heart failure and is associated with increased mortality. Yet, it is often underdiagnosed and inadequately treated. Lack of disease-specific and easy-to-administer screening tools is one of the reasons for underdiagnosis of depression in heart failure. We examined the effect of depression, as diagnosed by a single question about depression caused by heart failure symptoms and affecting quality of life, in a propensity score-matched cohort of heart failure patients. Of the 581 patients enrolled in the quality-of-life sub-study of the Digitalis Investigation Group trial, 298 (51%) reported that their heart failure prevented them from living as they wanted during the last month by making them feel depressed. Seventy patients (23%) who reported that they felt "much" or "very much" depressed were considered depressed for the purpose of this study. We matched 47 (67%) of these depressed patients with 47 patients from among the 283 patients without depression. Kaplan-Meier and matched Cox regression analyses were used to estimate associations of depression with mortality and hospitalizations during a median follow up of 33 months. Compared with 8 (17%) deaths in patients in the non-depressed group, 19 (40%) of those in the depressed group died from all causes [unadjusted hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.004-2.39; p=0.048]. Adjustment for propensity scores (adjusted HR, 1.77; 95% CI, 1.04-3.00; p=0.034) or other covariates (adjusted HR, 1.85; 95% CI, 1.12-3.04; p=0.016) did not alter the association between depression and mortality. The association, however, became marginally significant in the matched cohort (HR, 2.50; 95% CI, 0.97-6.44; p=0.058). There was no significant association between depression and hospitalization. Baseline depression, identified by a single disease-specific question, was associated with increased mortality among ambulatory chronic heart failure patients.
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PMID:Disease-specific depression and outcomes in chronic heart failure: a propensity score analysis. 1800 15

An optimal crossing distance exists within plant populations if inbreeding and outbreeding depression operate simultaneously. In a population of tetraploid Digitalis purpurea, maternal plants were pollinated with donors at four distances: 0 (self-pollination), 1, 6 and 30 m. Lifetime fitness of F1 progeny was investigated in greenhouse experiments, and significant inbreeding and outbreeding depression were detected at five vs. three life history traits. Inbreeding depression increased at later life stages, whereas outbreeding depression was relatively constant. The existence of within-population outbreeding depression suggests substantial genetic structuring at moderate distances in D. purpurea, and corroborates recent findings of significant outbreeding depression in F1 progeny in polyploids. The moderate inbreeding depression found in this predominately outcrossing population supports the notion that effects of inbreeding are less severe in polyploids than in diploids.
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PMID:Inbreeding depression and outbreeding depression in Digitalis purpurea: optimal outcrossing distance in a tetraploid. 1834 41


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