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Digitalis

Digitalis Preparation


Presentation

  • Three patients presented a digital cup on the electrocardiogram. In our series, in digoxin overdosage, 3 patients with electrical signs of digoxin overdosage have all 3 digoxin-beta-blockers.[ncbi.nlm.nih.gov]
  • Localization of the block has been found remarkable since, according to hitherto clinical studies, digitalis-induced Wenckebach block had been present commonly in the atrioventricular node.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 23-year-old pregnant woman with mitral regurgitation complicated with preeclampsia and pulmonary edema presented 2 episodes of atrial tachycardia induced by a intravenous digitalis (2 mg, IV and 1 mg, IV, respectively).[ncbi.nlm.nih.gov]
  • Abstract Six cases of digitalis intoxication presenting with cardiac arrhythmias are described.[ncbi.nlm.nih.gov]
  • Abstract A case of anorexia, paranoid delusions, and lethargy associated with digoxin toxicity is presented here. The digitalis glycosides are among the most commonly used drugs in modern medicine, and as such, they frequently cause toxicity.[ncbi.nlm.nih.gov]
Vomiting
  • A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes.[ncbi.nlm.nih.gov]
  • Symptoms may include gastrointestinal disturbances and pain, severe headache, nausea, vomiting, diarrhea, irregular pulse, and yellow vision ... "European Resuscitation Council". [ verification needed ] Lee Lopez, Orchid (2011).[en.wikipedia.org]
  • Causing vomiting . Other conditions . More evidence is needed to rate the effectiveness of foxglove for these uses. Foxglove contains chemicals from which the prescription medication digoxin (Lanoxin) is made.[emedicinehealth.com]
  • Signs of toxicity include nausea, vomiting, and an irregular heartbeat. To prevent DT, monitor your intake of digitalis to make sure you’re not taking too much of the medication.[healthline.com]
  • Methods to cause vomiting are usually not done because vomiting can worsen slow heart rhythms. In severe cases, medicines called digoxin-specific antibodies may be prescribed. Dialysis may be needed to reduce the level of digitalis in the body.[medlineplus.gov]
Nausea
  • If you are given too much digoxin you may lose your appetite or develop nausea (feeling sick), headache or blurred / coloured vision.[heartfailurematters.org]
  • Symptoms may include gastrointestinal disturbances and pain, severe headache, nausea, vomiting, diarrhea, irregular pulse, and yellow vision ... "European Resuscitation Council". [ verification needed ] Lee Lopez, Orchid (2011).[en.wikipedia.org]
  • Signs of toxicity include nausea, vomiting, and an irregular heartbeat. To prevent DT, monitor your intake of digitalis to make sure you’re not taking too much of the medication.[healthline.com]
  • Mountains, Piedmont, Coastal Plain Family: Scrophulariaceae Origin: Europe Poison Part: Leaves, flowers, seeds; overdoses of the drug digitalis Poison Delivery Mode: Ingestion, confusion with Symphytum (comphrey) and brewed into a toxic tea Symptoms: Nausea[plants.ces.ncsu.edu]
  • Smith et al. (1982) describe the symptoms of digoxin and digitoxin toxicity, including nausea and severe vomiting. Many people develop hyperkalemia.[web.archive.org]
Colic
  • The typical symptoms of an intoxication occurred, including high-grade ventricular and supraventricular tachyarrhythmias, colic abdominal pain, and peripheral paralysis.[ncbi.nlm.nih.gov]
Tachycardia
  • , atrial tachycardia with block, and multifocal tachycardia were observed.[ncbi.nlm.nih.gov]
  • Abstract Medical treatment of fetal tachycardias has substantially improved neonatal outcome over the past years.[ncbi.nlm.nih.gov]
  • Abstract Electrophysiological studies were performed in a patient with chronic chagasic cardiomyopathy, recurrent sustained ventricular tachycardia, and a history (without electrocardiographic documentation) of paroxysmal atrial flutter.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 23-year-old pregnant woman with mitral regurgitation complicated with preeclampsia and pulmonary edema presented 2 episodes of atrial tachycardia induced by a intravenous digitalis (2 mg, IV and 1 mg, IV, respectively).[ncbi.nlm.nih.gov]
  • Bidirectional ventricular tachycardia Bidirectional ventricular tachycardia is particularly characteristic of severe digitalis toxicity and results from alterations in intraventricular conduction, junctional tachycardia with aberrant intraventricular[emedicine.com]
Slow Pulse
  • pulse, tremors, unusual color visions, convulsions Toxic Principle: Cardiac or steroid glycosides Severity: HIGHLY TOXIC, MAY BE FATAL IF EATEN![plants.ces.ncsu.edu]
  • According to Withering, "the Foxglove, when given in large and quickly-repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine...slow pulse, even as slow as 35[aaas.org]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[emedicinehealth.com]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness , excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[webmd.com]
  • pulses, even as low as 35 in a minute, cold sweats, convulsions, syncope, death."[emedicine.com]
Muscle Weakness
  • SIDE EFFECTS: Diarrhea, loss of appetite, drowsiness, headache, muscle weakness, and fatigue may occur as your body adjusts to the medication.[medicinenet.com]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[emedicinehealth.com]
  • CNS headache Malaise confusion muscle weakness delirium drowsiness parasthesia hallucination 15. VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16.[slideshare.net]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness , excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[webmd.com]
Blurred Vision
  • Inform your doctor if you develop: confusion, visual disturbances ( blurred vision or yellow/green halos around objects), fast/slow/irregular heartbeat, skin rash, breast enlargement, severe stomach upset.[medicinenet.com]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[emedicinehealth.com]
  • VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16.[slideshare.net]
  • Signs of foxglove poisoning include stomach upset, small eye pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness , excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, abnormal heartbeats, and death[webmd.com]
Diplopia
  • VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16.[slideshare.net]
Confusion
  • Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab , a sheep antibody fragment with high affinity for digoxin.[ncbi.nlm.nih.gov]
  • CNS headache Malaise confusion muscle weakness delirium drowsiness parasthesia hallucination 15. VISUAL changes halos blurred vision amblyopia Yellow vision scotoma diplopia 16.[slideshare.net]
  • […] late summer Exposure: Partial shade Soil: Moist, well-drained soil Regions: Mountains, Piedmont, Coastal Plain Family: Scrophulariaceae Origin: Europe Poison Part: Leaves, flowers, seeds; overdoses of the drug digitalis Poison Delivery Mode: Ingestion, confusion[plants.ces.ncsu.edu]
  • You might experience confusion. Although rare, you might also see bright spots, have blurry vision, or experience blind spots. In addition, you might urinate much more or less than usual. Your body could also become swollen.[healthline.com]
  • According to Withering, "the Foxglove, when given in large and quickly-repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine...slow pulse, even as slow as 35[aaas.org]

Workup

  • (See Presentation and Workup .) During the early 20th century, as a result of the work of Cushny, Mackenzie, Lewis, and others, the drug was gradually recognized as specific for treatment of atrial fibrillation .[emedicine.com]
First-Degree Atrioventricular Block
  • Both men presented in first-degree atrioventricular block and had digoxin levels of 4.9 μg/litre, but were otherwise stable and made unremarkable recoveries with repeated dose activated charcoal.[ncbi.nlm.nih.gov]
Atrioventricular Dissociation
  • After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol.[ncbi.nlm.nih.gov]
Ventricular Hypertrophy
  • Abstract Patients with chronic renal failure develop a cardiomyopathy characterized by marked diastolic dysfunction and left ventricular hypertrophy.[ncbi.nlm.nih.gov]
Left Ventricular Hypertrophy
  • Abstract Patients with chronic renal failure develop a cardiomyopathy characterized by marked diastolic dysfunction and left ventricular hypertrophy.[ncbi.nlm.nih.gov]

Treatment

  • Abstract Medical treatment of fetal tachycardias has substantially improved neonatal outcome over the past years.[ncbi.nlm.nih.gov]
  • It is suggested that patients with PMD may respond to symptomatic treatment modulating nerve conduction.[ncbi.nlm.nih.gov]
  • Recently, with the introduction of potent diuretics and other agents for the treatment of these conditions, there has been a deemphasis on the role of digitalis despite its therapeutic value.[ncbi.nlm.nih.gov]
  • Digitalis remains a treatment that is difficult to manage, especially in the elderly.[ncbi.nlm.nih.gov]
  • AUTHORS' CONCLUSIONS: The literature indicates that digitalis may have a useful role in the treatment of patients with HF who are in normal sinus rhythm.[ncbi.nlm.nih.gov]

Prognosis

  • One study suggests that adolescents are more susceptible to digoxin on a mg/kg basis. [18] Prognosis Prognosis in digitalis toxicity worsens with increasing age and associated comorbid conditions.[emedicine.com]

Etiology

  • The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.[emergency.cdc.gov]
  • (See Etiology and Epidemiology .) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley.[emedicine.com]

Epidemiology

  • We performed this systematic review of available epidemiological studies to clarify the association between digitalis use and the risk of breast cancer.[ncbi.nlm.nih.gov]
  • Probable : A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for digitalis exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case[emergency.cdc.gov]
  • (See Etiology and Epidemiology .) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • This Review focuses on the role of endogenous cardiotonic steroids in the pathophysiology of essential hypertension, congestive heart failure, end-stage renal disease and pre-eclampsia.[ncbi.nlm.nih.gov]
  • These two areas merged with the hypothesis that natriuretic hormone and the vascular Na/K-ATPase inhibitor were the same factor, and furthermore, that this factor played a causative role in the pathophysiology of certain types of hypertension.[ncbi.nlm.nih.gov]
  • The Holter/signal averaging electrocardiogram substudy examined the pathophysiology of sudden cardiac death.[clinicaltrials.gov]
  • Pathophysiology Digoxin and other cardiac glycosides cause direct vasoconstriction in the arterial and venous system in vascular smooth muscle.[emedicine.com]

Prevention

  • DESIGN: In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the[ncbi.nlm.nih.gov]
  • In addition, some recommendations for prevention and management of this problem are discussed.[ncbi.nlm.nih.gov]
  • Thus, magnesium-stimulated paralysis was prevented by treatment with lithium carbonate and digitalis, which blocked the active ion transport.[ncbi.nlm.nih.gov]
  • Finally, we will provide evidence suggesting that stabilising RyR2 function could result in a potential new strategy to prevent cardiotonic glycoside-induced arrhythmias that could lead to a safer and more extensive use of these compounds.[ncbi.nlm.nih.gov]
  • Short-term use may be associated with an increased risk of esophageal squamous cell carcinoma, colorectal cancer, gallbladder cancer, and pancreatic cancer.The use of digitalis as preventive or therapeutic agents remains to be fully evaluated.[ncbi.nlm.nih.gov]

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