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

Eighteen neonates in heart failure were investigated to assess whether high or low serum digoxin levels had differing effects on left ventricular function as determined by systolic time intervals obtained by echocardiography. Nine patients had digoxin levels of 1.99 +/- 0.35 ng/ml (group 1). Nine others had levels of 3.62 +/- 0.95 ng/ml (group 2). Systolic time intervals were obtained by echocardiography before and at 5 days after digoxin and correlated with serum levels. The heart rate, preejection period (PEP), left ventricular ejection time (LVET), electromechanical systole (QS2) and the PEP/LVET ratio were measured. LVET and electromechanical systole were indexed. These measurements were analyzed and the two groups were compared using Student's t test. The clinical improvement in both groups was similar and no difference in ECG changes were noted. Therapy with digoxin produced changes in heart rate and systolic time intervals in both groups. Both showed significant shortening of electromechanical systole index; group 1 significantly shortened the LVET index and PEP/LVET ratio, whereas group 2 significantly shortened the PEP. Statistical analysis comparing the two groups showed no difference between them. Digoxin produces measurable changes in the indices of left ventricular function. The magnitude of these changes suggests no therapeutic advantage to the higher levels.
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PMID:Noninvasive assessment of left ventricular function related to serum digoxin levels in neonates. 736 May 42

The hemodynamic effects of dobutamine were compared with those of digoxin in six patients with cardiac failure within 24 hours of onset of acute myocardial infarction. Dobutamine (8.5 microgram per kilogram of body weight per minute) was given intravenously for 30 minutes and then discontinued until hemodynamics returned toward base line. Digoxin (12.5 microgram per kilogram) was then given intravenously, and hemodynamics were recorded for 90 minutes. Dobutamine decreased left ventricular filling pressure (from 22.3 to 9.8 mm Hg, P < 0.02) and systemic vascular resistance (1686 +/- 188 to 1259 +/- 108 dynes . sec . cm-5), and increased cardiac index (from 2.4 to 3.2 liters per minute per square meter of body-surface area, P < 0.005) and stroke work index (from 24.6 to 36.6 g . m per square meter, P < 0.02), without changing heart rate or arterial pressure. In contrast, digoxin had no effect on filling pressure (18.3 versus 17.0) and only a slight effect on cardiac index (2.2 versus 2.4, P < 0.05) and stroke work index (21.9 versus 27.6, P < 0.05). Thus, dobutamine markedly increased cardiac output, decreased filling pressure, and relieved pulmonary congestion. Digoxin, did not affect preload or afterload.
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PMID:A comparison of digoxin and dobutamine in patients with acute infarction and cardiac failure. 741 2

A patient with fetal paroxysmal supraventricular tachycardia (PST) with a heart rate above 300 beats/minute in the 29th week of pregnancy is described. The fetus showed signs of severe cardiac failure and was, therefore, digitalized by giving the mother 0.5 mg digoxin intravenously on the first day and the 0.25 mg oral digoxin daily throughout the pregnancy. After one day a normal rhythm was observed. The patient was delivered of a healthy girl after 38 weeks of pregnancy. Digoxin concentrations in samples of umbilical cord vein and artery, intrapartum scalp capillary, and amniotic fluid were almost equal, but somewhat lower than in simultaneously obtained maternal serum. Intrauterine digoxin treatment of fetuses with PST is discussed.
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PMID:Intrauterine digoxin treatment of fetal paroxysmal tachycardia. Case report. 742 4

Both prevalence and incidence of heart failure rise with age. Diagnosis of heart failure in the older patient may be difficult because of atypical symptoms or the acceptance of symptoms as manifestations of old age. Heart failure is not a diagnosis but a syndrome. Echocardiograms should be obtained in most elderly patients to aid diagnosis and assessment. Loop diuretics, taking into account the altered homoeostasis of old age and presence of co-morbidity, are the mainstay of symptomatic treatment. ACE inhibitors are likely to benefit survival, although formal trials have failed to include many older patients. Digoxin and direct vasodilators are less well tolerated in elderly patients.
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PMID:Heart failure in the elderly patient. 754 52

A 24 h intravenous dosing regimen of amiodarone was designed to reach a peak plasma concentration at 1 h and to maintain the concentration above a certain level during the infusion period. A randomized, open-label, digoxin-controlled study was undertaken to observe the efficacy and safety of the dosing regimen of amiodarone in treating recent-onset, persistent, atrial fibrillation and flutter with ventricular rates above 130 beats.min-1. Fifty patients with a mean age of 70 +/- 7 (SD) years were enrolled and randomly assigned to receive either amiodarone intravenously (n = 26) or digoxin (n = 24). Amiodarone HCl was infused over 24 h according to the following regimen: 5 mg.min-1, 3 mg.min-1, 1 mg.min-1 and 0.5 mg.min-1 for 1, 3, 6 and 14 h, respectively, for a 70-kg subject. Digoxin (0.013 mg.kg-1) was infused in three divided doses, each dose 2 h apart and infused over 30 min. The mean heart rates in the amiodarone group decreased significantly from 157 +/- 20 beats.min-1 to 122 +/- 25 beats.min-1 after 1 h (P < 0.05 vs baseline), and then decreased further to stabilize at 96 +/- 25 beats.min-1 after 6 h (P < 0.05). The digoxin group had fewer dramatic alterations in heart rates, compared to the amiodarone group, in the first 8 h (P < 0.05, respectively). Maximum reduction was reached only after 8 h. The amiodarone infusion was prematurely aborted in two patients due to severe bradycardia and death after conversion in one patient and aggravation of heart failure in the other.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. A randomized, digoxin-controlled study. 767 84

The available data suggest that digitalis improves symptoms of a failing heart in the presence of sinus rhythm as well as supraventricular arrhythmias. Intravenous digitalis administration in patients with chronic heart failure and baseline hemodynamic deterioration increases cardiac index and reduces heart rate. These beneficial effects are maintained with long-term oral therapy and are comparable with those obtained using dobutamine in patients with chronic severe heart failure. The addition of digoxin to therapy with vasodilators and diuretics confers clinical benefit in patients with moderate to severe heart failure symptoms because of systolic ventricular dysfunction. Digoxin effects on diastolic function appear to be different in patients with preserved systolic function in comparison to patients with overt heart failure and systodiastolic dysfunction. In patients with right ventricular dysfunction digoxin does not appear to influence hemodynamic measurements unless concomitant left ventricular dysfunction is present.
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PMID:A reexamination of the hemodynamic effects of digitalis relative to ventricular dysfunction. 772 13

Contractile properties and micromorphology of the human myocardium were studied in bioptates of the right auricula at the heart failure and its pharmacological correction. It is shown that the chronoinotropic dependence of trabecular muscles of the human heart is a negative one. Vegetation of the connective tissue in the myocardium begins at the stage of development of its hypertrophy. Digoxin in combination with diuretics improves contractile properties and decreases expressiveness of dystrophic changes in myocardiocytes. Combination of the mentioned means with a blocker of the renin-angiotensin system, kapothenum in particular, not only improves the state of the contractile apparatus of the heart, but also causes a reverse development of the hyperplasive connective tissue.
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PMID:[Morphological and functional characteristics of myocardium in patients with cardiac insufficiency and its pharmacologic correction]. 775 7

In a 4 1/2 year period fetal, echocardiographic studies were performed on 1600 fetuses. In 55 with arrhythmia, 44 had supraventricular ectopic beats, resolved in all, and none had heart disease. Sustained arrhythmias occurred in 11 fetuses. Atrial flutter was present in 3 all with heart disease (Ebstein disease, right atrial tumour and WPW diagnosed after birth). Another 3 fetuses had supraventricular tachycardia (SVT), all with a normal heart. In the bradycardia group, 2 had complete heart block (CHB) associated with AVSD; 2 sinus bradycardia and one had non conducted atrial ectopic beats. Digoxin was the first choice drug for tachyarrhythmia therapy; association with Verapamil, Flecainide, Quinidine and Procainamide was used in 4 of the 6. One fetus with CHB received Orciprenaline with no results. Atrial flutter resolved or improved; in SVT 2 fetuses converted to sinus rhythm and one died in utero. All fetuses with CHB died in cardiac failure. Mortality was 27% (3 cases) in utero and global 36%. In our experience most fetal arrhythmias (90%) were transitory ectopic beats or non lasting bradycardia in normal heart and did not trigger other kinds of arrhythmias. In sustained arrhythmias, heart failure and heart disease had a negative effect on prognosis.
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PMID:[Fetal arrhythmia. A case load of 4 years and a half]. 777 Dec 7

Two hundred and ninety one patients admitted with atrial fibrillation through the emergency room of a regional hospital in the year 1993 were reviewed to evaluate the presenting features and in-hospital treatment of patients with symptomatic atrial fibrillation. The incidence of atrial fibrillation increased with age (mean age was 73 +/- 12 years) and the ratio of female to male was 1.8:1. The commonest presenting features were palpitation (42.3%), dyspnoea (38.1%) and heart failure (16.4%). The most frequently associated cardiac conditions were hypertension (28.9%), atherosclerotic cardiovascular disease (24.7%) and rheumatic heart disease (17.5%). Pulmonary diseases (18.6%), diabetes mellitus (12.7%) and thyrotoxicosis (6.2%) were the principal associated non-cardiac conditions. Thromboembolic complications were found in 15 patients at presentation (5.2%). Cardiac enzyme assessment was investigated in two thirds of the patients (68.1%), while thyroid function test (59.5%) and echocardiography (29.6%) were less commonly investigated. Digoxin was still the most popular drug used for ventricular rate control, and cardioversion was performed in only 6.9% of patients. Antithrombotic therapy was used in 5.8% of patients only although it was clinically indicated in more than half of the patients (52%). Contraindications of anticoagulation were found in 23 patients (7.9%), including a history of gastrointestinal or cerebrovascular bleeding, active bleeding, chronic renal failure and poor drug compliance. The mean hospital stay was 5 +/- 4 days, compared to a mean stay of 2.7 days for other medical patients. Fourteen patients (4.8%) died during hospitalisation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital. 778 42

Digoxin and other low doses of drugs that have inotropic properties may have an important role to play in the therapy of patients with chronic heart failure. There is convincing evidence that digoxin is effective in relieving the signs and symptoms of heart failure due to systolic dysfunction. While earlier results with some of the other agents have been disappointing, recent data suggest that a reevaluation of these agents is necessary. There is now compelling evidence that lower doses of these agents may be clinically useful without necessarily having any significant hemodynamic effects. The recent experience with vesnarinone is especially promising in showing that therapy with these agents may improve survival in addition to improving clinical status. It is becoming recognized that hemodynamic activity should not necessarily be a prerequisite for clinical utility for those agents. The neuroendocrine and electrophysiologic effects of many of these agents, including digitalis, remain incompletely characterized and may play an important role in their therapeutic benefit. It appears that certain drugs that have inotropic properties may be effective only when their inotropic effects are not readily demonstrated. Further research into the appropriate mechanisms of action and proper dosing of these drugs may lead to a renewed interest in the use of positive inotropes for chronic heart failure.
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PMID:Reassessment of digoxin and other low-dose positive inotropes in the treatment of chronic heart failure. 787 74


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