[Clinical investigation of effects of digitaline Nativelle and cedilanid].
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The authors of the article studied potential of various drug combinations (atenolol + enalapril + indapamide, and celanid + enalapril + indapamide) in complex treatment of patients with heart failure (HF) and supraventricular arrhythmias. The subjects were 106 patients, of whom 74 had coronary heart disease, of whom 51 had old myocardial infarction, and 18 had undergone coronary artery bypass grafting. Dilatation cardiomyopathy was found in 8, aortomitral valvular disease--in 18, and combined mitral valvular disease--in 6 patients. 36 subjects had permanent atrial fibrillation, 48--a paroxysmal form of ciliary arrhythmia, 22--paroxysms of atrial tachycardia. NYHA functional class (FC) II HF was diagnosed in 64 patients, NYHA FC III HF--in 42 patients. According to what treatment regimen was applied, the patients were divided into two groups, comparable in the main clinical and functional characteristics. Two-month therapy resulted in improvement of hemodynamics, increase of activity tolerance and improvement of life quality in both groups. The combination celanide + enalapril + indapamide in individual doses was effective in FC II-III HF with supraventricular arrhythmias. The cost of treatment with celanid is lower.
OBJECTIVE: To investigate the effectiveness and safety of various agents on paroxysmal atrial fibrillation in the elderly over 75 years old. METHODS: Totally 264 in-patients (75-91 years old, 185 males and 79 females) with atrial fibrillation history of less than 7 days were enrolled in this study. A total of 611 atrial fibrillation episodes were recorded, but 130 episodes (22.3%) of atrial fibrillation were auto-converted to sinus rhythm. The rest 481 episodes of atrial fibrillation were divided into six groups based on the drug used. RESULTS: The cardioversion ratio of atrial fibrillation were 9.5%, 46.9%, 71.7%, 55.9%, 32.7%, and 73.6% in control, cedilanid, amiodarone, propafenone, verapamil, and quinidine groups, respectively. Ventricular rate control were 5.4%, 83.6%, 84.9%, 77.9%, 78.8%, and 11.3% in those groups, respectively. The total effective rates of amiodarone and cedilanid groups were the highest. When the ventricular rate was controlled to below 90 bpm, the patients would almost complain of no discomfort. No severe side-effect was observed in each group. CONCLUSION: Amiodarone and cedilanid may be the proper drugs for the treatment of paroxysmal atrial fibrillation in the elderly. The above antiarrhythmics in each therapeutic group were relatively safe and effective.
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The effect of ganglionic blockade on cardiotoxicity induced by deslanoside (25 mug/kg i.v. at 15-minute intervals) was evaluated in Dial-urethane anesthetized cats. Electrocardiogram, blood pressure and pre- and postganglionic cardiac sympathetic nerve recordings were monitored. When deslanoside was given to control animals, 150 +/- 8.2 and 179 +/- 11.9 mug/kg produced ventricular tachycardia and ventricular fibrillation, respectively. Pretreatment of cats with either hexamethonium or atropine alone did not influence the doses of deslanoside required to produce ventricular tachycardia or ventricular fibrillation. However, pretreatment with the combination of hexamethonium and atropine significantly increased the dose of deslanoside needed to produce ventricular tachycardia (181 +/- 12.3 mug/kg) and ventricular fibrillation (219 +/- 12.3 mug/kg). Furthermore, administration of atropine to hexamethonium-pretreated cats intoxicated with deslanoside decreased deslanoside-induced postganglionic nerve activity. These results indicate that blockade of both nicotinic and muscarinic ganglionic transmission is essential for a protective influence against cardiotoxicity induced by deslanoside.
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Digoxin, digitoxin and acetyldigitoxin are the most widely prescribed of cardiotonic glycosides. Analytical exploration can be performed by a single assay when only one compound is prescribed or by multiple assays in cases of imprecise prescription or when several glycosides are given concomitantly. In addition, the metabolic transformation of digitoxin into digoxin and the presence of endogenous "digitalis-like compounds" mean that a number of precautions must be taken during prescription. These examples underline the ambiguity of the so-called "digitalinaemia" prescriptions and the need for biologists to be supplied with maximum information by clinicians.
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10 patients with acute digitalis intoxication were treated by charcoal hemoperfusion. The patients had taken high toxic and lethal doses of digitalis drugs: 3 patients had taken 10 mg of (digitalin, 2 patients--7.5 mg of digoxin, 5 patients--10-25 mg of isolanid (ceglunat). 4 of the patients were with a heart disease and the other 6 patients did not have any heart disease. The charcoal hemoperfusion lasted 4 to 6 hours, in one female patient--2 hours. The mean minute volume was 100 to 150 ml/min, in some patients it reached up to 200 ml/min. The digoxin blood concentration was determined before and after the hemoperfusion in 4 patients and a decrease of 49% was found. 9 patients fully recovered and only one patient, a 70 years old women, who had not received antiarrhythmic treatment, died. Good results were also achieved in digitalin intoxications determined by the clinical course and the electrocardiographic data. The overall estimation of the method is that it is efficient and should be applied to patients with acute digitalis intoxication, always in combination with antidote, antiarrhythmic and cardioprotective treatment.
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The influence of Deslanoside C (D), 1.2 mg intravenously on the systolic time intervals (STI) was assessed in 15 individuals with right ventricular pacemakers, who were studied on two occasions, ten days apart. In the first case D was given under basal conditions, and in the second after autonomic blockade (with practolol 20 mg intravenously and atropine 1.5 and 1.0 mg intravenously) at 1 hour's interval. There were similar changes of the STI with digitalis administration both before and after automic blockade. Autonomic blockade is not necessary for full expression of digitalis action on the human heart, as advocated by some authors to be the case in experimental animals.
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