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digoxin management

Bülent Özlek, Eda Özlek, Mehmet Tekinalp, Serkan Kahraman, Hicaz Zencirkıran Ağuş, Oğuzhan Çelik, Cem Çil, Bedri Caner Kaya, İbrahim Rencüzoğulları, Kadir Uğur Mert, Mustafa Ozan Çakır, Altuğ Ösken, Lütfü Bekar, Yunus Çelik, Özcan Başaran, Volkan Doğan, Gurbet Özge Mert, Kadriye Memiç Sancar, Samet Sevinç, Murat Biteker
OBJECTIVES: To compare real-world characteristics and management of individuals aged 80 and older with heart failure (HF) and mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) derived from a large cohort of survey and to compare them with those younger than 80 from the same survey. METHODS: This is an observational, multicenter and cross-sectional study conducted in Turkey (NCT03026114). Consecutive 1,065 (mean age of 67...
March 13, 2019: International Journal of Clinical Practice
Eiichiro Oka, Yu-Ki Iwasaki, Eugene Maru, Yuhi Fujimoto, Kanako Ito-Hagiwara, Hiroshi Hayashi, Teppei Yamamoto, Kenji Yodogawa, Meiso Hayashi, Wataru Shimizu
BACKGROUND: Landiolol, an ultra-short acting β1 -selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function...
February 28, 2019: Circulation Journal: Official Journal of the Japanese Circulation Society
Lei Zhang, Zahid Hussain, Zhuanqin Ren
BACKGROUND: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess cerebrospinal fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, blurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH. OBJECTIVE: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of effectiveness of employed therapeutic intervention for NPH...
February 14, 2019: Current Drug Targets
Zahid Hussain, Lei Zhang, Zhuanqin Ren
BACKGROUND: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess cerebrospinal fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, blurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH. OBJECTIVE: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of effectiveness of employed therapeutic intervention for NPH...
February 14, 2019: Current Drug Targets
Julene S Carvalho
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy...
January 9, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
Betty S Chan, Geoffrey K Isbister, Colin B Page, Katherine Z Isoardi, Angela L Chiew, Katharine A Kirby, Nicholas A Buckley
INTRODUCTION: In our previous study on chronic digoxin poisoning, there was a minor improvement after treatment with digoxin-specific antibody (digoxin-Fab). We hypothesised patients with elevated digoxin concentrations may derive little benefit from digoxin-Fab because their presenting complaint was more closely related to their multiple co-morbidities. We aimed to compare the outcome of patients who were initially treated with digoxin-Fab with those that received supportive care. METHOD: Patients were prospectively recruited to the study if they had an elevated digoxin concentration, signs or symptoms of toxicity thought to be from digoxin...
December 26, 2018: Clinical Toxicology
Sarju Ganatra, Ajay Sharma, Sachin Shah, Ghulam M Chaudhry, David T Martin, Tomas G Neilan, Syed Saad Mahmood, Ana Barac, John D Groarke, Salim S Hayek, Saurbha Dani, David Venesy, Richard Patten, Anju Nohria
Ibrutinib, a novel and potent Bruton tyrosine kinase inhibitor, is an effective and well-tolerated treatment for a variety of B-cell lymphomas. However, its use is associated with an increased incidence of atrial fibrillation (AF), ranging from 4% to 16%. We reviewed the original clinical trials that led to the approval of ibrutinib, as well as several other prospective and retrospective studies, to better appreciate the incidence of ibrutinib-associated AF. Based on 16 studies included in our analysis, the incidence of ibrutinib-associated AF was 5...
December 2018: JACC. Clinical Electrophysiology
Joanna Osmanska, Pardeep S Jhund
The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction...
December 11, 2018: Drugs & Aging
Ilektra Voulgareli, Alexandra Chronaiou, Dionisios Tsoukalas, George Tsoukalas
We report a case of endogenous lipoid pneumonia secondary to long-term use of amiodarone (> 30 years) for atrial fibrillation in a 76-year-old Caucasian woman, presenting with cough and dyspnea. Endogenous Lipoid pneumonia is a rare underdiagnosed condition more prevalent in adults. It is usually asymptomatic and a diagnosis is generally made in patients who have become clinically unstable or when an abnormal lung shadow is found on a chest X-ray. In the case here described it was diagnosed by fiberoptic bronchoscopy with bronchoalveolar lavage (BALF) where fat-laden macrophages (oil red O stain) were identified...
2018: Pneumonia
Martin Aguilar, Stanley Nattel
The vast majority of clinical arrhythmia-management research over the past couple of decades has focused on catheter-based therapeutic advances. There has been much less emphasis on rate-control strategies; however, the majority of patients with atrial fibrillation (AF) will require some form of rate-control management, making AF rate-control the single most widely used therapeutic component in AF-patients. While the general principles governing AF rate-control have remained largely unchanged, they are often underappreciated...
November 15, 2018: International Journal of Cardiology
Aaron B Kaye, Amar Bhakta, Alex D Moseley, Anupama K Rao, Sally Arif, Seth J Lichtenstein, Neelum T Aggarwal, Annabelle S Volgman, Rupa M Sanghani
Cardiovascular disease is now the leading cause of pregnancy-related deaths in the United States. Increasing maternal mortality in the United States underscores the importance of proper cardiovascular management. Significant physiological changes during pregnancy affect the heart's ability to respond to pathological processes such as hypertension and heart failure. These physiological changes further affect the pharmacokinetic and pharmacodynamic properties of cardiac medications. During pregnancy, these changes can significantly alter medication efficacy and metabolism...
November 8, 2018: Journal of Women's Health
Martin Aguilar, Stanley Nattel
Despite major advances in atrial fibrillation (AF) catheter ablation, rate control remains the most widely used management strategy for AF in the general population. In addition to its use as a primary approach to control symptoms and prevent complications of AF, rate control is often a necessary complement to rhythm-control strategies, especially with antiarrhythmic drugs. The value of rate-control therapy is supported by several large randomized clinical trials showing no difference in major cardiovascular outcomes between rate-control and rhythm-control strategies with currently available therapeutic approaches (antiarrhythmic drugs and/or catheter ablation)...
November 2018: Canadian Journal of Cardiology
Lucy M Bracken, Betty S H Chan, Nicholas A Buckley
CONTEXT: Recommended doses of digoxin-specific antibody fragments (digoxin-Fab) for treatment of acute digoxin poisoning are pharmacokinetically unsubstantiated and theoretically excessive. Physiologically based pharmacokinetic (PBPK) modelling creates clinical simulations which are closely related to physiological and pharmacokinetic behaviour. This paper details the formulation of a PBPK model of digoxin and explores its use as a simulation tool for acute digoxin toxicity and its management...
October 11, 2018: Clinical Toxicology
Elise J Smolders, Peter J G Ter Horst, Sharon Wolters, David M Burger
Direct-acting antivirals (DAAs) are known victims (substrate) and perpetrators (cause) of drug-drug interactions (DDIs). These DAAs are used for the treatment of hepatitis C virus (HCV) infections and are highly effective drugs. Drugs used for cardiovascular risk management are frequently used by HCV-infected patients, whom also are treated with DAAs. Therefore, the aim of this review was to describe DDIs between cardiovascular drugs (CVDs) and DAAs. An extensive literature search was performed containing search terms for the marketed DAAs and CVDs (β-blocking agents, ACE inhibitors, angiotensin II antagonists, renin inhibitors, diuretics, calcium channel blockers, statins/ezetimibe, fibrates, platelet aggregation inhibitors, vitamin K antagonists, heparins, direct Xa inhibitors, nitrates, amiodarone, and digoxin)...
September 27, 2018: Clinical Pharmacokinetics
Jeffrey B Washam, Manesh R Patel
PURPOSE OF REVIEW: A number of recent observational analyses have assessed clinical outcomes associated with digoxin use in patients with atrial fibrillation. In this review, we review these data and provide suggestions on the contemporary use of digoxin in patients with atrial fibrillation as supported by the recent evidence. RECENT FINDINGS: Observational data from clinical trials and registries have provided variable results on the safety and efficacy of chronic digoxin use in patients with atrial fibrillation...
September 12, 2018: Current Cardiology Reports
Mahmoud Hassanein, Magdy Abdelhamid, Bassem Ibrahim, Mohamed Sobhy, Gamela Nasr, Mohamed Wafaie Aboleineen, Ashraf Reda, Nabil Farag, Ahmed Elshazly, Tarek Khairy Abdeldayem, Fatma Elmesseiry, Hesham Boshra, Hesham Sobhy, Atef Elbahry, Amr Youssef, Medhat Ashmawy, Ahmed Abdelmoneim, Ayman Saleh, Yahya Elrakshy, Hamdy Ebeid
AIMS: This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry. METHODS AND RESULTS: From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate...
December 2018: ESC Heart Failure
Sidra Khalid, Samin Yasar, Aariez Khalid, Timothy Pp Spiro, Abdo Haddad, Hamed Daw
Background Ibrutinib is a Bruton's tyrosine kinase inhibitor, which is United States Food and Drug Administration (FDA)-approved for chronic lymphocytic leukemia, mantle cell lymphoma, and Waldenström's macroglobulinemia. Ibrutinib is associated with atrial fibrillation and bleeding events. Our aim is to determine the management of prior atrial fibrillation when starting ibrutinib, as well as ibrutinib-induced atrial fibrillation. Our focus is on which rate and rhythm control strategies to use and decisions regarding the use of antiplatelet and anticoagulation agents...
May 29, 2018: Curēus
Niklas Bobrovitz, Carl Heneghan, Igho Onakpoya, Benjamin Fletcher, Dylan Collins, Alice Tompson, Joseph Lee, David Nunan, Rebecca Fisher, Brittney Scott, Jack O'Sullivan, Oliver Van Hecke, Brian D Nicholson, Sarah Stevens, Nia Roberts, Kamal R Mahtani
BACKGROUND: Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement...
July 26, 2018: BMC Medicine
Natali Jokanovic, Noha Ferrah, Janaka J Lovell, Carolina Weller, Lyndal Bugeja, J Simon Bell, Joseph E Ibrahim
BACKGROUND: Residential aged care is a complex and challenging clinical setting where medication errors continue to occur despite efforts to improve medication safety. No studies have sought to review and synthesize coronial investigations into medication-related deaths in Australian residential aged care facilities (RACFs). OBJECTIVE: To review coronial investigations into medication-related deaths in Australian RACFs. METHODS: A national review of medication-related deaths between July 2000 and July 2013 reported to Australian Coroners was performed...
June 12, 2018: Research in Social & Administrative Pharmacy: RSAP
Abrar-Ahmad Zulfiqar, Paul Blazejczyk, Nadir Kadri, Jean Doucet
Digitalis remains a treatment that is difficult to manage, especially in the elderly. METHODS: A retrospective, unicentric study carried out within the unit of Internal medicine and geriatrics, Reims University Hospital Center, between January and June 2014. Collection of all patients hospitalized, after 75 years, receiving treatment with digitalis, either as soon as they enter (present on the usual prescription of the patient), during their hospitalization and on their exit. RESULTS: 20 patients were included...
June 1, 2018: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
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