Congestive heart failure digitalis

GC Oliver, R Tazman, R Frederickson. Influence of congestive heart failure on digoxin level. In O Storstein, ed. Symposium on Digitalis. Oslo Gyl-dendal Norsk Forlag, 1973, pp. 336-347. 

The outcome of this is to couple ATP hydrolysis with the vectorial transport of Na+ and K+ across the plasma membrane. The inhibition of the (Na+-K+)-ATPase by cardiac glycosides such as digitalis (an extract of foxglove leaves), which blocks the dephosphorylation of the E2-P form of the enzyme, is the basis for a number of steroid drags which are commonly prescribed for the treatment of congestive heart failure. 

Congestive heart failure (CHF) For the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin, in conjunction with digitalis, diuretics, and ACE inhibitors, to reduce the progression of disease. 

Fluid overload occurs commonly in patients with renal failure, often in the absence of associated heart disease. If salt and water intake is not controlled in the patient who is oliguric or anaemic, plasma volume and symptoms of congestive heart failure ensue. Hypertension and coronary heart disease with increasing age contributes to the congestive heart failure. Diuretics like loop-diuretics or metolazone may be of value. Digitalis should be used with caution in patients on dialysis as cardiac arrhythmias may ensue in patients receiving dialysis in the presence of hypokalemia. 

Digitalis functions to improve congestive heart failure by... 

Historically, plant-based natural products have been a source of useful drugs. The analgesic opiates come from the poppy plant. Digitalis for congestive heart failure was first isolated from the foxglove plant. Various antibiotics (penicillin) and anticancer agents (taxol) are derived from natural product sources. There are numerous other examples. 

It is indicated in all grades of essential hypertension and renovascular hypertension where standard therapy is ineffective or inappropriate because of adverse effects and in congestive heart failure. It should be used as an adjunctive therapy with digitalis and/or diuretics. 

Crude leaf preparations of Digitalis have been in medical use since 1785. Pure cardiac glycosides are now available. These preparations in injectable tinctures or powdered leaf tablets are used extensively for the treatment of congestive heart failure. They increase the force of the heart muscle and the power of systolic contraction, apparently by inhibiting the active transport of K and Na ions through cell membranes. 

Dopamine and dobutamine are sometimes used to stimulate the heart in cases of acute or severe heart failure (see Chapter 20). Dopamine and dobutamine exert a fairly specific positive inotropic effect, presumably through their ability to stimulate beta-1 receptors on the myocardium.60 Other beta-1 agonists (epinephrine, prenalterol, etc.) will also increase myocardial contractility, but most of these other beta-1 agonists will also increase heart rate or have other side effects that prevent their use in congestive heart failure. Dopamine and dobutamine are usually reserved for patients with advanced cases of congestive heart failure who do not respond to other positive inotropic drugs (e.g., digitalis).6,72... 

ACE inhibitors are now considered one of the mainstays of treatment in congestive heart failure. These drugs are the first agents shown to prolong the life span of people with this disease 60 that is, digitalis, diuretics, and other drugs commonly used to treat heart failure may all produce symptomatic improvements, but the use of ACE inhibitors alone or in combination with these drugs actually results in decreased mortality.32,60... 

Hood WB, Jr, Dans AL, Guyatt GH, et al. Digitalis for treatment of congestive heart failure in patients in sinus rhythm. Cochrane Database Syst Rev. 2004 CD002901. 

FIGURE 35.5 Actions of digitalis in congestive heart failure. 

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