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

Since William Withering first described the use of digitalis, over 200 years ago (1), its popularity has waxed and waned. Digitalis preparations are widely prescribed for elderly patients. Surveys of hospital in-patients have shown a high prevalence of the use of digitalis preparations (2, 3), but also of digitalis toxicity; though not all studies have shown the latter to increase with age. A survey of people aged 70, living in Gothenberg, showed that 14% were taking digitalis preparations (4); other studies have shown similar figures. Now that powerful diuretics and vasodilators are available for the treatment of heart failure, and many antiarrhythmics are used for the control of atrial tachyarrhythmias, there is controversy about the value of cardiac glycosides in the treatment of elderly patients.
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PMID:Digitalis in the elderly. 351 80

Ninety-four patients on digitalis treatment for chronic congestive heart failure (NYHA class II-III) were enrolled for a 12 month trial in a random, double-blind, placebo-controlled study. After a placebo run-in period, patients were assigned to placebo or captopril 25 mg t.i.d. Digitalis was continued while diuretics were withdrawn. Clinical status, exercise capacity, cardiac dimensions and performance were evaluated with a full physical examination, 12 lead ECG, chest X-ray, 24 hour Holter monitoring, bicycle effort capacity, M-mode echocardiography and radionuclide ventriculography at 1, 2 and 3 weeks and 1, 2, 3, 6 and 12 months. There were no significant differences in the trend of survival curves after six months follow-up between the captopril or placebo treatment groups. Patients treated with captopril, without the addition of diuretics, had an improvement in NYHA class (P less than 0.01), an increase in exercise capacity (P less than 0.025), a decrease in cardiothoracic ratio (P less than 0.025) and an increase of echocardiographic left ventricular contractility (P less than 0.005). Only four patients treated with captopril were withdrawn from the follow-up for allergic side effects. Preliminary results at 6 months prove that captopril, compared to placebo, is useful in mild to moderate heart failure.
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PMID:Captopril in mild heart failure: preliminary observations of a long-term, double-blind, placebo-controlled multicentre trial. 353 52

Magnesium (Mg2+) plays a significant role in the electrical stability of the heart and hypomagnesemia may predispose patients to arrhythmias and digitalis toxicity. We measured the serum and skeletal muscle Mg2+ content of patients with chronic Chagasic cardiomyopathy (CCC) during treatment for congestive heart failure and compared it to 15 normal patients who were used to establish the normal values of our population. There is a high frequency of muscle Mg2+ deficiency (66%) in patients with CCC during treatment for heart failure. However, serum Mg2+ is not a sensitive index of deficiency, since hypomagnesemia occurred in only 50% of the patients whose muscle Mg2+ was low. Digitalis toxicity was observed in all muscle Mg2+-deficient patients (100%) and in 25% of patients with normal Mg2+ levels (P less than or equal to 0.05). Ventricular tachycardia (VT) occurred in 75% of muscle Mg2+-deficient patients and in none of the patients with normal magnesium levels (P less than or equal to 0.05). The frequency and severity of premature ventricular contractions (PVC) were higher in muscle Mg2+-deficient patients. We conclude that muscle Mg2+ deficiency is very common in patients with CCC being treated for congestive heart failure and that muscle Mg2+ deficiency defines a higher risk CCC group in terms of digitalis toxicity and severe ventricular arrhythmias such as ventricular tachycardia.
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PMID:Muscle magnesium content and cardiac arrhythmias during treatment of congestive heart failure due to chronic chagasic cardiomyopathy. 380 26

Though he received his medical education in Edinburgh, William Withering was born and bred, and conducted his practice, in the Midlands of England, where he collaborated closely with medical and nonmedical colleagues who were pioneers of intellectual thought during the industrial revolution. Because of his profound botanical knowledge, he was able to identify Digitalis purpurea as the essential ingredient in a prescription dispensed by a herbalist, and systematically proceeded to show its value in patients with cardiac failure. He identified the cardinal symptoms of digitalis intoxication and worked out effective rules for the prescription of an infusion of digitalis. Withering's careful observations were also extended to botany and geology, and he was a key figure in the intellectual and scientific life of his area, a man whose legacy is not only the agent he identified but also the scrupulous way in which he evaluated it.
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PMID:The foxglove, "The old woman from Shropshire" and William Withering. 388 50

Over the last ten years the efficacy of lithium salts in cluster headache has been well demonstrated. Our patient, who had been suffering from cluster headache for approximately 30 years, had been in haemodialysis treatment for the last ten years for chronic renal failure. Moreover, he was affected by heart failure and peptic ulcer. The patient was currently under therapy with Digitalis, Isorbide dinitrate, and ranitidine and was dialyzed three times a week for a total of five hours each time. Neither prophylactic headache therapy nor high doses of analgesic drugs had proved effective. Although this patient was in haemodialysis, lithium treatment was indicated. The administration of lithium carbonate 300 mg during dialysis days and 150 mg during non-dialysis days improved the attacks. Complete recovery from the attacks was obtained when the serum levels of lithium reached the therapeutic range. No side effects were noted.
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PMID:Cluster headache: clinical efficacy of lithium salts in a haemodialysis treated patient. 401 22

The frequency of therapy with digitalis glycosides was determined in 4.143 patients on their first visit at a medical outpatient clinic. 508 (12.3%) patients said to take digitalis. Of 480 (94.5%) patients, a digoxin serum concentration was obtained. It was in 229 (47.7%) patients below, in 31 (6.5%) above, and in 220 (45.8%) within the therapeutic range (0.8-2.0 ng/ml). From the 251 patients with a serum digoxin concentration greater than or equal to 0.8 ng/ml, 220 (87.7%) were not included in a withdrawal trial on the basis of predetermined criteria, mainly because of cardiac diseases (52%). Digitalis therapy was withdrawn in 31 patients. 5 patients started to take the drug again on their own; they were considered drop-outs. In the remaining 26 patients, no symptoms of heart failure appeared during a 3-month observation period; in 2 patients, however, atrial fibrillation requiring intervention occurred. Our results confirm the frequent use of digitalis therapy in Germany, but also the frequent presence of subtherapeutic serum digoxin concentrations. Withdrawal should be considered in patients with a questionable indication for this therapy; the occasional occurrence of supraventricular arrhythmias, and not so much of heart failure, should be anticipated.
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PMID:[Digitalis therapy: prescription frequency, serum concentrations and withdrawal trials]. 404 2

The effect of therapeutic doses of digitalis in modifying neural activity has been the subject of considerable controversy. In earlier studies we reported an increase both in serotonergic activity in the posterior hypothalamus and pons-medulla and in cardiac sympathetic tone in the failing cardiomyopathic hamster. In this study we examine the effects of doses of digitoxin, known to be therapeutic for hamster heart failure, on monoamine neurotransmitter metabolism in the brain and heart during the cardiomyopathy. Both digitoxin and ASI-222, a polar amino-glycoside which does not cross the blood-brain barrier, given either acutely (6 mg/kg ip) or chronically (2 mg/kg/day ip for 10 days), normalized the failure-induced increase in serotonin turnover in the pons-medulla but had no effect on the changes in the posterior hypothalamus. Digitoxin therapy also reduced cardiac and adrenal sympathetic activity partially restoring cardiac catecholamine stores. In order to more clearly define the pathways involved we measured serotonin (microgram/g protein) in 18 brain nuclei after 10 days of digitoxin or vehicle treatment. Heart failure was associated with an increase in serotonin in five nuclei: the mammillary; bodies, ventromedial, periventricular and paraventricular nuclei of the hypothalamus, and the centralis superior nucleus of the raphe. Digitoxin therapy completely normalized the changes in the centralis superior and ventromedialis nuclei; neither congestive heart failure nor digitoxin affected serotonin levels in other nuclei. We conclude that there is an increase in activity in specific brain serotonergic nuclei in congestive heart failure. Digitalis reduces cardiac sympathetic tone and restores the changes in two of these nuclei: the ventromedial and the centralis superior.+2
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PMID:Digitoxin therapy partially restores cardiac catecholamine and brain serotonin metabolism in congestive heart failure. 407 5

Digitalis glycosides remain the cornerstone of treatment in cardiac failure. The increasing frequency of toxic effects is a cause for concern. Review of 80 elderly patients receiving digoxin on a maintenance basis, some of whom had toxic effects, shows that in almost three-quarters of the group digoxin was stopped without detriment. Elderly patients on maintenance treatment should be reviewed, and in the absence of a known primary cardiac lesion an attempt should be made to withdraw digoxin.
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PMID:Maintenance digoxin in elderly patients. 542 54

Cardiac accidents induced by various types of drugs are examined and risk factors are identified in this article. Digitalis preparations are responsible for the largest number of accidents, but their frequency diminishes when prescription rules are respected. Overdoses are often announced by digestive complaints, while more serious problems arise at the stage of intoxication. Theophylline is used as a bronchial muscle relaxant but also has a cardiac effect. All antiarhythmics except bretylate are negative inotropes and can aggravate cardiac insufficiency. Beta-blockers were relatively well tolerated if the contraindications are respected. The main risks are decompensation for a cardiac insufficiency and aggravation of an auriculoventricular block. The risks of antiangina preparations are mostly provoked by their vasodilation action. Neurotropic drugs usually entail minimal alterations in the electrocardiogram but a variety of serious problems may arise with massive ingestion. Cardiotoxicity is rare in anticancer drugs and has mostly been noted in anthracyclinic products. Accidents with local anesthetics are not rare despite their daily use, while general anesthetics vary in their risk levels. A variety of other medications have been found or suspected to entail risks. Myocardial infarction in young, healthy oral contraceptive (OC) users has been observed but the mechanism of action is unclear. The necessity of ruling out risk factors before prescribing combined pills has been underlined. It is difficult to compile a complete list of all drugs having cardiovascular repercussions and the action of some drugs is probably still undiscovered. In most cases the complications are dose-related and predictable. Exceptions to this rule exist, as with OCs.
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PMID:[Drugs and the cardiovascular system]. 613 12

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.
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PMID:[Trial for digitalis withdrawal in hemodialysis patients]. 623 Feb 17


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