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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Digitalization by direct intramuscular injection of the fetus successfully controlled supraventricular tachycardia at 24 weeks' gestation after more traditional intensive trials of transplacental therapy with digoxin, verapamil, and procainamide, either separately or in combination, had failed. The fetal pharmacokinetics were calculated from fetal blood samples obtained by cordocentesis. No clear evidence of placental transfer of digoxin administered to the mother could be found despite a digoxin concentration in the mother that ranged from 1.8 to 2.6 ng/ml for 4 days. After direct fetal digitalization we calculated that the coefficient of elimination for digoxin from the fetus was 0.0463 h-1, and digoxin elimination half-life was 15.9 hours. The latter time span is substantially less than the 50-hour half-life previously reported in newborn infants with low birth weight. The fetal/maternal concentration ratio of procainamide was 0.914. However, maternal clearance of procainamide (9.7 ml/kg-1/min-1) was twice as long as the clearance reported for nonpregnant patients undergoing fast acetylation. We conclude first, that at least in the dose of this ill fetus, little digoxin administered to the mother crossed the placentae; and second, that while direct fetal therapy with digoxin is effective, the necessary frequent number of injections render this therapy impractical. Direct fetal digitalization should probably be reserved for the preterm fetus who has evidence of heart failure and has not responded to maternally administered therapy other than digoxin.
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PMID:Direct treatment of fetal supraventricular tachycardia after failed transplacental therapy. 334 17

During 1980-7, 23 pregnancies of 22-38 weeks' duration were investigated for fetal tachycardia. Twelve were cases of supraventricular tachycardia, eight of atrial flutter, and three cases in which the rhythm varied between supraventricular tachycardia and atrial flutter. In 11 cases the fetus had developed non-immune fetal hydrops before referral; 12 cases were non-hydropic at referral but one of this group of fetuses became hydropic during treatment. No relation was found between the rate or type of arrhythmia and the presence or absence of intrauterine heart failure. One non-hydropic infant was delivered electively prematurely. Maternal antiarrhythmic treatment was instituted in the remaining 22 cases. Conversion of the arrhythmia was achieved with digoxin alone in five cases and with a combination of digoxin and verapamil in nine. Control of the arrhythmia was achieved in seven of the 10 non-hydropic fetuses, and all were delivered at term with no deaths. Of the 12 hydropic fetuses, control was achieved in seven. Only three of the hydropic fetuses were delivered close to term. There were two deaths, both in the hydropic group. Of the whole group, five neonates suffered severe complications of prematurity. In this series the main benefit of treatment appeared to be in prolonging gestation of those hydropic fetuses in which conversion was achieved.
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PMID:Obstetric importance, diagnosis, and management of fetal tachycardias. 340 29

Intrauterine supraventricular tachycardia is one of the main causes of non-immunological intrauterine hydrops fetalis. Without early diagnosis and treatment it may terminate in fetal death or delivery of a baby with severe hydrops and extreme heart failure. With the improvement in non-invasive imaging techniques in prenatal medicine, this condition can be diagnosed early and treated successfully. A case is described of such a newborn diagnosed in utero and treated before and after delivery, and the different therapeutic approaches to congenital supraventricular tachycardia are discussed.
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PMID:Severe hydrops fetalis due to congenital supraventricular tachycardia. 351 28

A chronic supraventricular tachycardia may alone be responsible for a picture of severe congestive cardiac insufficiency, which is totally reversible after return to a sinus rhythm. The two cases reported here emphasize this particular fact, the physiopathology of which still remains unknown. There is also a prognostic advantage to such cases: in the presence of a congestive cardiopathy with atrial fibrillation, apparently idiopathic, it is important to try to obtain a sinus rhythm and to study from a distance the left ventricular performance indexes which may return to normal after regularization of the rhythm.
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PMID:[Auricular fibrillation: a cause of reversible myocardiopathy]. 367 19

The efficacy of verapamil in the conversion of 47 episodes of supraventricular tachycardia in 22 children was evaluated. The age of the patients ranged from 15 days to 10 years. Tachycardia was the main mode of presentation. Ten out of 22 children had viral infections. Two patients developed mild cardiac failure. Six patients had underlying cardiac abnormalities. Forty-four out of 47 episodes of supraventricular tachycardia were converted to sinus rhythm by a single dose of verapamil (0.11 +/- 0.08 mg/kg). No significant side-effects were observed. Intravenous verapamil is an effective and safe drug for the conversion of supraventricular tachycardia in children.
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PMID:Efficacy of verapamil in the conversion of supraventricular tachycardia in Singapore children. 368 11

To determine their perioperative risk, we reviewed the records of 35 patients with hypertrophic cardiomyopathy diagnosed by cardiac ultrasound and/or catheterization who underwent general (52) or spinal (four) anesthesia--a total of 56 major surgical procedures. There were no operative or related perioperative deaths and no significant ventricular tachyarrhythmias. Intraoperative or postoperative complications included: myocardial infarction with heart failure in one patient who also had coronary artery disease and was one of three patients who had spinal anesthesia, arrhythmia requiring therapy in eight, and angina during supraventricular tachycardia in one. We conclude that the risk of general anesthesia and major noncardiac surgery is low in patients with hypertrophic obstructive cardiomyopathy. Spinal anesthesia, which decreases systemic vascular resistance and increases capacitance, may be relatively contraindicated. Concomitant coronary artery disease may increase the risk.
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PMID:Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy. 404 65

The most often causes of cardiac arrhythmias in aged patients are heart failure as a consequence of coronary or of hypertensive heart disease, hypersensitive carotis-sinus, digitalisintoxication and hypokalemia. Out of that, the different tachyarrhythmias and bradyarrhythmias and often also a tachycardia-bradycardia-syndrome may develop. Appropriately it results the most often kinds of antiarrhythmic therapy as the treatment of heart failure with digitalis, diuretics and nitrates, the handling of electrostimulation with pacemakers, the removal of digitalis and the supply of potassium. Beyond of that, there are many antiarrhythmic drugs, selected for therapy of "first choice". These are betablockers in sinustachycardia, ajmaline in supraventricular ectopic beats, verapamile in supraventricular tachycardia, lidoflazine with propafenone in atrial fibrillation, propafenone in ventricular ectopic beats, lidocaine in ventricular tachycardia, electrodefibrillation in ventricular fibrillation, orciprenaline, atropine and electrostimulation in bradyarrhythmias. The relation of advantage and risk of an antiarrhythmic therapy has to be considered carefully, especially in higher decades. Mostly it is already sufficient, to avoid arrhythmias by a critical and controlled prescription of digitalis, diuretics and laxatives.
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PMID:[Treatment of cardiac arrhythmias in aged patients (author's transl)]. 615 69

A double-blind placebo-controlled crossover trial of digoxin withdrawal was undertaken in 22 patients with sinus rhythm who had a previous history of frank heart failure and were taking therapeutic doses of the drug. During the course of the study, 14 patients showed no clinical change whether taking digoxin or placebo, five patients deteriorated on placebo (four with heart failure and one with supraventricular tachycardia), and three on digoxin (two with heart failure and one with digoxin toxicity). These differences were not statistically significant. Compared to placebo, patients, while taking digoxin, had lower resting heart rates and significant shortening of all the systolic time intervals. The drug appears to exert a sustained positive inotropic effect during maintenance therapy, but this is not of clinical benefit to the majority of patients.
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PMID:Digoxin withdrawal after cardiac failure in patients with sinus rhythm. 618 95

In a fetus with supraventricular tachycardia (SVT) and cardiac failure, normal sinus rhythm (NSR) was restored with maternal digoxin therapy at 26 weeks' gestation. The diagnosis of cardiac failure was based on ultrasound evidence of ascites and scalp edema. Cardiac failure was attributed to the persistent SVT. The infant remained in NSR and was delivered at 36 weeks' gestation because of persistent ascites. Intracardiac anatomy was normal. This case confirms the usefulness of prenatal ultrasound examinations in the diagnosis of fetal SVT and cardiac failure and illustrates the effectiveness and safety of transplacental digoxin therapy in the management of fetal SVT.
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PMID:Successful treatment of fetal supraventricular tachycardia with maternal digoxin therapy. 636 44

Intrauterine fetal supraventricular tachycardia (ISVT) is a rare condition which is connected with organic heart disease in only 4-10 per cent. However, neonatally these children develop heart failure in a high frequency (62 per cent). Intrauterine digitalization has been suggested as treatment, especially if the fetus is preterm. Fetal therapeutic concentrations might demand doses inconvenient to the mother. We hereby report one case of intrauterine SVT in the 26th gestational week treated with a standard dose of digoxin resulting in subtherapeutic umbilical digoxin levels. When no consistent influence on fetal heart rate could be seen, verapamil (80 mg x 3) was added to the treatment. A reversion of the tachycardia and the fetal ECG changes was achieved within two days. The verapamil treatment could be withdrawn after ten days, while the digoxin treatment was continued. An initial discrete heart enlargement also was reversed by the treatment. The delivery in gestational week 38 was uneventful and the child did well. A neonatal ECG showed a sinus rythm interfoliated with supraventricular extrasystoles. No signs of organic heart disease have appeared. When last seen at nine months of age, the ECG was normal and digoxin had been discontinued without recurrence of tachycardia.
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PMID:Treatment of intrauterine supraventricular tachycardia with digoxin and verapamil. 650 42


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