Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Case histories of four elderly patients with central nervous system signs of digitalis toxicity were reviewed. Evidence of toxicity included lethargy, depression which was not present previously, confusion, restlessness, emotional instability, hyperventilation, and vertigo. Vomiting developed four days after the onset of the mental changes. No cardiac arrhythmias were observed. Digoxin serum levels ranged between 4.2 and 7.0 ng/ml. Serum potassium values were within normal limits. Three of the four patients recovered with a return of their mental status to the pretoxic state. The fourth case was fatal. At autopsy long-standing myocardial ischemia was the only significant finding.
 ...
PMID:Digitalis delirium in elderly patients. 53 71

Poisoning is a significant problem in the elderly. The majority of poisonings in older people are unintentional and may result from dementia and confusion, improper use of the product, improper storage or mistaken identities. Depression is also common in the elderly and suicide attempts are more likely to be successful in this age group. The elderly patient's recuperative abilities may be inadequate as a result of numerous factors including impaired hepatic or renal function as well as chronic disease processes. General management of poisoning in the elderly parallels management of younger adults, but it is especially important to ascertain underlying medical conditions and concurrent medications. In most poisonings, activated charcoal and cathartic are sufficient. Haemodialysis or haemoperfusion may be required at lower plasma drug concentrations in elderly patients. While the specific indications for antidotes are the same for all age groups, dosage alterations and precautions may need to be considered in the elderly. Drugs most often implicated in poisonings in the elderly include psychotherapeutic drugs, cardiovascular drugs, analgesics and anti-inflammatory drugs, oral hypoglycaemics and theophylline. Cardiovascular and neurological toxicities occur with overdoses of neuroleptic drugs and, more frequently and severely, with cyclic antidepressants. Patients with pre-existing cardiovascular disease are at particular risk of worsening ischaemic heart disease and congestive heart failure. Benzodiazepines only appear to produce significant toxicity during long term administration or in combination with other CNS depressants. Digoxin can cause both chronic and acute intoxication, most seriously cardiac toxicity including severe ventricular arrhythmias, second or third degree heart block or severe refractory hyperkalaemia. Immune Fab antibody is indicated for the management of digoxin toxicity, although patients dependent on the inotropic effect of digoxin may develop heart failure after digoxin Fab antibody administration. Nitrates can cause toxicity including headache, vomiting, hypotension and tachycardia from excessive sublingual, transdermal or intravenous doses. Conduction disturbances and hypotension occur with overdoses of antihypertensive drugs; these effects are mild with angiotensin converting enzyme (ACE) inhibitors, occasionally severe with beta-blockers and of significant concern with calcium channel antagonists. The elderly commonly use aspirin and other salicylates, are more likely to develop chronic intoxications to these agents, and are more susceptible to severe complications such as pulmonary oedema. Salicylate poisoning, recognition of which is often delayed, should be considered in elderly patients with neurological abnormalities or breathing difficulties, especially in the setting of acid-base abnormalities. The clinical effects of NSAID overdose are mild and usually involve the central nervous system and gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Poisoning in the elderly. Epidemiological, clinical and management considerations. 179 7

Causes of congestive heart failure include hypertension, coronary artery disease, alcohol abuse and valvular heart disease. Two-dimensional echocardiography with Doppler examination is excellent for identifying valvular heart disease. While noninvasive screening for coronary artery disease may seem cost-effective, the consequences of a missed diagnosis are such that coronary angiography should be strongly considered if there is any suggestion of ischemic heart disease. Medical management primarily consists of vasodilators, diuretics and inotropic agents. Vasodilator therapy may prolong the patient's life. Digoxin and diuretics improve symptoms and hemodynamic abnormalities. With advanced heart failure, adequate control of fluid retention and dyspnea may require diuretic doses associated with azotemia, and systolic blood pressure may have to be maintained at less than 100 mm Hg in spite of postural hypotension.
 ...
PMID:Congestive heart failure. 220 40

Fifty-one patients with symptomatic ventricular tachycardia who failed control on current anti-arrhythmics were studied. Seventy-four percent had ischemic heart disease and 81% had congestive heart failure. Patients underwent serial 24 Holter recordings and radionuclide ventriculography before, during dose titration and during long-term mexiletine therapy. Twenty-eight patients (55%) were successfully controlled. Of these, 17 (33%) remained controlled greater than or equal to 1 year. Early and late side effects were common but benign and included mostly gastric pain and nausea. Twenty-eight patients underwent radionuclide ventriculography before and during mexiletine therapy: there was no significant difference in heart rate, blood pressure, left ventricular ejection fraction, stroke volume and end-diastolic volumes before and during mexiletine. Left ventricular ejection fraction was 21.4 +/- 2.2%, (SD) and 21.3 +/- 2.2% (SD) before and during mexiletine respectively. Digoxin blood levels measured in 15 patients were not significantly changed by mexiletine. In conclusion, mexiletine is effective and safe in many patients with intractable ventricular tachycardia. It has no significant hemodynamic effects even in patients with congestive heart failure nor does it affect digoxin blood levels. Its usefulness is limited by a high incidence of gastric intolerance.
 ...
PMID:Mexiletine: long-term efficacy and hemodynamic actions in patients with ventricular arrhythmia. 241 74

The author describes the hemodynamic changes typical of burn shock and burn disease and emphasises the typical features of the phases of burn shock ("ebb", "flow"). The author also stresses that the myocardial insufficiency of the burned patients is due to the changes of preload-afterload, disturbances of the myocardial compliance and desynchronisation of the left-right ventricular function. If the injured were pretraumatically heart patients (COCM, ischemic heart disease) fluid replacement in these cases is an appropriate heart therapy. The choice of further treatment is based upon normalization of PVR, TPR "compliance" and oxygenization of myocardium. In the "ebb" phase of shock vasodilators and Ca-entry blockers, in the "flow" phase beta-adrenergic blockers are suggested. In every severe case due to ischemia induced by metabolic and hemodynamic changes, NG (and derivatives) treatment is justified. The author considers the application of positive inotropic agents in all the cases as unreasonable and proves their necessity (Dobutrex, Digoxin) only after objective determination of decreased contractility.
 ...
PMID:Cardiac support in burned patients with heart disease. 247 16

Controversy continues concerning the use of digoxin as a positive inotropic agent in the treatment of heart failure in patients in sinus rhythm. Digoxin is properly used to control the heart rate in patients in atrial fibrillation. The findings from 14 uncontrolled and 6 controlled clinical trials have been examined. Digoxin does exert a small chronic positive inotropic effect. Although some individual patients, particularly those with fluid overload, appear to benefit from digoxin, controlled clinical trials in patients, most of whom have been treated with diuretics, have failed to demonstrate an increase of exercise capacity. No mortality trial has been attempted. Digoxin has the potential to be harmful in patients with ischemic heart disease. Alternative and safer therapies have been shown to be equal or superior to digoxin.
 ...
PMID:Digoxin--a redundant drug in congestive cardiac failure. 248 85

Digoxin and sidnopharm were used in the treatment of 60 patients with initial stages of chronic circulatory insufficiency in IHD with a maintained sinus rhythm. It was established that sidnopharm in adequately selected doses possesses an essential antianginal effect with minor manifestations of side-effects, results in a favourable hemodynamic unloading of the heart and may be used in monotherapy of these patients.
 ...
PMID:[The effectiveness of digoxin and sidnofarm in the initial stages of chronic circulatory failure]. 261 91

After examining the properties of the 3 most widely used calcium antagonists, the paper assesses the efficacy of Diltiazem in reducing blood pressure rises after exercise in a group of 7 patients with chronic atrial fibrillation. The blood pressure response to a standard load (50 W x 3 m2) on the exercise cycle was monitored in a group of patients under chronic digitalis treatment (phase I) after which the same patients' response to varying doses of Diltiazem (180-240 mg/day) was assessed (phase II) and finally (phase III) their response to treatment with Diltiazem alone but no digitalis. A significantly greater reduction in the systolic pressure and heart rate after exercise was noted in patients given Diltiazem with or without Digoxin than in those given digitalis alone. It is therefore concluded that Diltiazem may be useful in controlled blood pressure and heart rate increases after exercise, especially in patients with ischaemic heart disease.
 ...
PMID:[Efficacy of diltiazem in blood pressure increase caused by exertion]. 274 39

The influence of digoxin, digitoxin and g-strophanthin (ouabain) on the sinus node function (recovery time, sinoatrial conduction time, PP-interval) and on ventricular repolarisation (corrected QT interval and QT during permanent atrial stimulation) was studied in 101 patients (36 with sick sinus syndrome-SSS, 34 with ischaemic heart disease-IHD, and 31 control patients without cardiac disease). Digoxin caused marked prolongation of sinoatrial conduction time (in SSS and in control patients), digitoxin prolonged the PP interval (in IHD and SSS patients); digitoxin and ouabain shortened the QTcorr in SSS patients, ouabain shortened also QT during atrial pacing. The results do not point to specific indication of individual glycosides in sinus node function disturbances. Under certain clinical prerequisites, however, digitoxin can be recommended in ventricular ectopic contractions caused by prolonged or inhomogeneous repolarisation, and also the capacity of ouabain to shorten the repolarisation time deserves attention.
 ...
PMID:[Acute electrophysiological effects of cardiac glycosides on sinus node function and ventricular repolarization under clinical conditions]. 343 48

Following a 90-min coronary occlusion and 2 h reperfusion in 11 dogs, total tissue and subcellular distributions of [3H]digoxin in non-ischemic and various ischemic tissues were measured. In the non-ischemic tissue, [3H]digoxin in the crude homogenate, sediments obtained from 1000 X g, 10000 X g and 100000 X g centrifugations, and final supernatant fraction were 0.70 +/- 0.05, 0.79 +/- 0.05, 0.64 +/- 0.04, 3.87 +/- 0.34 and 0.19 +/- 0.02 ng/mg protein, respectively. As in studies with total tissue [3H]digoxin uptake, a reciprocal correlation was observed in reduction of digoxin binding in the crude homogenates and the 1000 X g sediments with increasing severity of ischemic injury estimated from the loss of nitro-blue-tetrazolium (NBT) stain. A 20% and 80% loss of NBT stain was associated with a 13.3% and 63.5% decrease in digoxin binding, respectively. In contrast, digoxin binding in the 10000 X g sediments increased progressively with the severity of ischemia. No significant change was observed in the final supernatant fraction. Digoxin binding in the 100000 X g sediments, which generally represent specific binding and which are associated with the pharmacologic effects, was not altered in tissues with a loss of NBT stain up to 50%. In fact, a loss of 80% NBT was associated with only a 33.9% decrease in digoxin binding. Thus, it appears that measurement of total tissue digoxin uptake does not provide an accurate measure of the effects of acute ischemia on specific digoxin binding. The ability of the peri- and moderately ischemic tissues (with less than 50% loss of NBT stain) to specifically bind digitalis was not altered after temporary myocardial ischemia.
 ...
PMID:Subcellular [3H]digoxin distribution after temporary myocardial ischemia in dogs. 630 74


1 2 Next >>