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Canadian Medical Association Journal Feb 1964
Topics: Bradycardia; Delirium; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Gynecomastia; Humans; Lanatosides; Male; Neuritis; Paresthesia; Tachycardia; Thrombocytopenia; Toxicology; Trigeminal Neuralgia; Urticaria
PubMed: 14122470
DOI: No ID Found -
Annals of Internal Medicine Dec 1950
Topics: Delirium; Digitalis; Digitalis Glycosides; Humans; Plant Extracts
PubMed: 14790518
DOI: 10.7326/0003-4819-33-6-1360 -
The American Journal of Medicine May 1950
Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Plant Extracts
PubMed: 15413630
DOI: 10.1016/0002-9343(50)90311-1 -
American Journal of Physiology. Heart... Dec 2022Cloning of the "Na pump" (Na,K-ATPase or NKA) and identification of a circulating ligand, endogenous ouabain (EO), a cardiotonic steroid (CTS), triggered seminal... (Review)
Review
Cloning of the "Na pump" (Na,K-ATPase or NKA) and identification of a circulating ligand, endogenous ouabain (EO), a cardiotonic steroid (CTS), triggered seminal discoveries regarding EO and its NKA receptor in cardiovascular function and the pathophysiology of heart failure (HF) and hypertension. Cardiotonic digitalis preparations were a preferred treatment for HF for two centuries, but digoxin was only marginally effective in a large clinical trial (1997). This led to diminished digoxin use. Missing from the trial, however, was any consideration that endogenous CTS might influence digitalis' efficacy. Digoxin, at therapeutic concentrations, acutely inhibits NKA but, remarkably, antagonizes ouabain's action. Prolonged treatment with ouabain, but not digoxin, causes hypertension in rodents; in this model, digoxin lowers blood pressure (BP). Furthermore, NKA-bound ouabain and digoxin modulate different protein kinase signaling pathways and have disparate long-term cardiovascular effects. Reports of "brain ouabain" led to the elucidation of a new, slow neuromodulatory pathway in the brain; locally generated EO and the α2 NKA isoform help regulate sympathetic drive to the heart and vasculature. The roles of EO and α2 NKA have been studied by EO assay, ouabain-resistant mutation of α2 NKA, and immunoneutralization of EO with ouabain-binding Fab fragments. The NKA α2 CTS binding site and its endogenous ligand are required for BP elevation in many common hypertension models and full expression of cardiac remodeling and dysfunction following pressure overload or myocardial infarction. Understanding how endogenous CTS impact hypertension and HF pathophysiology and therapy should foster reconsideration of digoxin's therapeutic utility.
Topics: Digitalis; Cardiac Glycosides; Ligands; Heart Failure; Hypertension
PubMed: 36367691
DOI: 10.1152/ajpheart.00362.2022 -
The American Journal of Cardiology Jun 1992The most important step in the management of toxicity due to any of the cardiac glycosides is its recognition. Despite the development of an accurate clinical assay for... (Review)
Review
The most important step in the management of toxicity due to any of the cardiac glycosides is its recognition. Despite the development of an accurate clinical assay for serum levels of digoxin greater than 20 years ago, digitalis toxicity remains common and difficult to confirm, even if suspected, due primarily to 2 factors. First, the signs and symptoms of digitalis toxicity, most commonly an abnormal electrocardiogram showing ventricular or atrial arrhythmias, with or without some degree of concurrent atrioventricular block, often also occur in patients with congestive heart failure (CHF) and underlying coronary atherosclerosis who are not receiving a cardiac glycoside. Second, due to digoxin's narrow therapeutic ratio, the marked degree of variability in the sensitivity of individual patients to its toxic effects, and the common problem of obtaining blood samples inappropriately during the early distribution phase following dosing, a serum digoxin concentration often does not serve as a reliable indicator of toxicity. Despite these difficulties in diagnosis, the management of digoxin toxicity has been made much more effective with the widespread availability of F(ab) fragments of anti-digoxin antibodies. This drug provides the clinician with a rapidly acting, safe antidote for all commonly used digitalis preparations. Conventional therapy for digoxin toxicity remains the maintenance of serum potassium levels greater than or equal to 4 mEq/liter, reversal of decompensated CHF or overt myocardial ischemia, attention to serum magnesium levels and the patient's acid-base status, appropriate antiarrhythmics in the event of ventricular arrhythmias, and a temporary pacemaker for high-grade atrioventricular block. Nevertheless, the high specificity and documented safety of the antibody preparation provides a needed safety net for the continuing use of cardiac glycosides as first-line inotropic agents in the modern therapy of chronic CHF.
Topics: Digitalis Glycosides; Heart Failure; Humans; Immunoglobulin Fab Fragments; Incidence; Poisoning; Risk Factors
PubMed: 1626485
DOI: 10.1016/0002-9149(92)91259-7 -
Journal of the American Medical... Apr 1948
Topics: Digitalis; Digitalis Glycosides; Plant Extracts
PubMed: 18933186
DOI: No ID Found -
Journal of the American Medical... Jun 1948
Topics: Digitalis; Digitalis Glycosides; Digitoxin; Plant Extracts
PubMed: 18860595
DOI: 10.1001/jama.1948.02890400035007 -
France Medecine Dec 1950
Topics: Digitalis; Digitalis Glycosides; Plant Extracts
PubMed: 14802523
DOI: No ID Found -
Memphis Medical Journal Mar 1949
Topics: Digitalis; Digitalis Glycosides; Plant Extracts
PubMed: 18114066
DOI: No ID Found -
The Bulletin of the Tulane Medical... Nov 1947
Topics: Digitalis; Digitalis Glycosides; Plant Extracts
PubMed: 18899094
DOI: No ID Found