Clinical utility of plasma digoxin measurements.

The results of plasma digoxin concentration (PDC) measurements in 260 patients treated with digitalis lanata preparations (digoxin, lanatoside C, betamethyl-digoxin) allowed the following observations: 1. Owing to an important overlap between "toxic" and "nontoxic" PDC values, the method has a limited value in the diagnosis of digitalis toxicity. However, in patients with toxicity associated with PDC under 2 ng/ml, it allows identification digitalis sensitivity. 2. A dosage selection based on PDC assessment led to a decrease of digitalis toxicity under 4%. As the method is not widely available, it has to be used in patients with borderline renal function, in aged subjects and in patients with rapid atrial fibrillation who require higher digitalis doses for heart rate control.

[Arrest of rhythmic disorders in an outpatient polyclinic]. / Prekusvane na ritumni narusheniia pri ambulatorno-poliklinichni usloviia.

The material has been collected for two years and covers 48 case with paroxysm of supraventricular paroxysmal tachycardia (28), auricular fibrillation (4), ventricular tachycardia (2), group and polytopic ventricular extrasystoles (14), with organic heart diseases (30) and with non-organic heart diseases (18). The paroxysms were coped with isolanid , tachmalin and lidocain , sow intravenous infusion under constant ECG, auscultatory and hemodynamic control and monitors. The number of the successfully coped paroxysms is 43. It proved to be possible to interrupt the rhythm disturbances under the conditions of non-integrated polyclinic in case of properly equipped functional consulting room. In this way the problem of early and effective treatment of rhythm disturbances under polyclinical conditions is solved, hence--avoiding both the unnecessary hospitalization of part of those patients and the delay in the initiation of effective treatment of the other part of them. The early diagnosis and adequate therapeutic behaviour of the physician towards the patient at their first contact till the moment of their transportation and hospitalization proved to be of particular significance. The out-patient department interruption of rhythm disorders should very cautiously be performed, particularly in case of ventricular tachycardia and polytopic extrasystoles, that being only their initial treatment.

The digital circulation in congestive heart failure.

Congestive heart failure (CHF) is a complex clinical entity which is still little understood pathophysiologically. Unless it is in the intractable state it responds well to therapy. It has been known for many years that the peripheral circulation can be dramatically altered when CHF is progressively and rapidly developing and worsening. As compensation develops, these changes gradually return to normal. We have long been studying the digital circulation of patients with CHF and have been impressed with the changes in the behavior of the peripheral blood vessels in these patients.

[Use of digitalis glycosides in severe disorders of intra-ventricular conduction]. / Utilisation des digitaliques en cas de troubles sévères de la conduction intra-ventriculaire.

The use of digitalis in severe disorders of intra-ventricular conduction is debatable, and some consider it contra-indicated. Once it had been shown that the latter attitude is at best based on contraversial theoretical arguments, two types of study were undertaken: 1. Nine patients with bilateral bundle branch block had intracavitary recordings made of the HV interval both before and for one hour after the administration of lanatoside C (0.8 to 1.6 mg). In no case was this interval found to be increased, indicating that there was no increase in the original conduction defect. 2. Thirty four patients with complete right bundle branch block and associated left antero-superior hemiblock were digitalised, and followed up for an average of 16 months; only 2 complete atrio-ventricular blocks occurred (5.9%). The risk of complete atrio-ventribular block occurring within a year (4.5% in our series) does not differ significantly from that in an identical control group of 38 patients with the same conduction defect, but who were not digitalised (6%). Three patients had a therapeutic overdose of digitalis with no observed increase in their atrio-ventricular block. The authors conclude that it is perfectly in order to digitalise a patient with a severe intra-ventricular conduction defect.

Use of digitalis in general practice. Liverpool Therapeutics Group.

A study, which arose out of a general-practitioner teaching programme in clinical pharmacology, was designed to assess the use of digitalis in 391 patients in general practice. Clinical, biochemical, and pharmacological data were used to assess whether digitalis treatment should be discontinued (89 patients; 22.8%); the dose kept unchanged (47; 12%); or the dose increased (47; 12%) or decreased (24; 6.1%). Serum concentrations of cardiac glycoside were below a defined therapeutic range in 159 patients (40.7%), above this range in 37 (9.7%), and within the range in 195 (49.3%). Studies of this kind may help to promote a more critical attitude to prescribing widely used drugs such as digitalis.