Chest
The Short-term Effects of Digoxin in Patients With Right Ventricular Dysfunction From Pulmonary Hypertension
Section snippets
MATERIALS AND METHODS
Seventeen consecutive patients with PPH referred to our medical center for an initial evaluation were entered into the study. All patients were evaluated by clinical history, physical examination, ECG, chest radiography, perfusion lung scanning, pulmonary function testing, echocardiography, and right heart catheterization. Secondary causes of pulmonary hypertension were excluded on the basis of criteria established by the National Institutes of Health Registry on PPH.17 Normal left ventricular
Demographics
Seventeen patients were studied, 14 women and 3 men. Their ages were 42±12 years. The patients had severe PPH as manifest by an elevated mean pulmonary artery pressure (61 ± 19 mm Hg) and pulmonary vascular resistance (15±8 U).
Effects of Digoxin on Hemodynamics
The effects of digoxin on the hemodynamics in these patients are shown in Table 1. There was a significant increase in cardiac output of approximately 10% (3.49 to 3.81 L/min, p=0.028), which was manifest by an increased stroke volume, as heart rate remained essentially
DISCUSSION
Digitalis is a time-honored treatment of congestive heart failure. In the past, most studies on the effects of digitalis have focused on hemodynamics and increased myocardial contractility. Data demonstrating beneficial effects of digitalis on parameters such as cardiac output,2 left ventricular filling pressure,19, 20, 21, 22 and systemic vascular resistance23,24 have been obtained primarily in patients with abnormal baseline hemodynamics. It has also been proposed that the clinical
REACTIONS
In our experience, digitalis toxicity in patients with pulmonary hypertension and normal renal function is distinctly uncommon. Given its ease of administration, its low cost, and its potential to improve circulatory derangements in these patients, we believe that digoxin is a potentially useful medication for patients who present with right ventricular failure, either with isolated pulmonary hypertension or in combination with left ventricular systolic failure. The poor prognosis and high
REFERENCES (42)
- et al.
A controlled trial of digoxin in congestive heart failure.
Am J Cardiol
(1988) - et al.
Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED Trial.
J Am Coll Cardiol
(1993) - et al.
The effect of digitoxin on the apparent stroke volume, posteroanterior cardiac diameter, and the cardiac cycle in normal subjects as studies by the electrokymograph.
Am Heart J
(1951) Digitalis and the autonomic nervous system.
J Am Coll Cardiol
(1985)- et al.
Proposal for the standardization of the calibration method for the assay of plasma catecholamines.
J Chromatogr
(1990) - et al.
Acute effects of digoxin on total systemic vascular resistance in congestive heart failure due to dilated cardiomyopathy: a hemodynamic-hormonal study.
Am J Cardiol
(1985) Effects of digitalis on the normal and the failing heart.
J Am Coll Cardiol
(1985)- et al.
Effects of digoxin on exercise capacity and right ventricular function during exercise in chronic airflow obstruction.
Chest
(1984) - et al.
Acute effects of digoxin on total systemic vascular resistance in congestive heart failure due to dilated cardiomyopathy: a hemodynamic-hormonal study.
Am J Cardiol
(1985) - et al.
Comparative hemodynamic and neurohormonal effects of intravenous captopril and digoxin and their combinations in patients with severe heart failure.
J Am Coll Cardiol
(1989)
Effect of long-term digoxin therapy on autonomic function in patients with chronic heart failure.
J Am Coll Cardiol
Adverse consequences of high sympathetic nervous activity in the failing human heart.
J Am Coll Cardiol
Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease.
J Am Coll Cardiol
Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: relation to hemodynamic variables and endothelin levels.
J Am Coll Cardiol
An account of the foxglove, and some of its medical uses: with practical remarks on dropsy, and other diseases.
Heart failure in outpatients: a randomized trial of digoxin versus placebo.
N Engl J Med
Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors.
N Engl J Med
The use of digitalis in patients with pulmonary disease.
Ann Intern Med
Digitalis intoxication: prospective clinical study with serum level correlations.
N Engl J Med
The influence of digitalis glycosides on the force of contraction of mammalian cardiac muscle.
J Pharmacol Exp Ther
Action of ouabain upon normal and hypodynamic myocardium.
Proc Soc Exp Biol Med
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