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Toxins in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Visual side effects of digitalis are less common than cardiac or other noncardiac symptoms. The spectrum of toxicity varies and includes decreased visual acuity, central scotomas or visual field reduction, photopsia most pronounced in daylight, photophobia, blurry or snowy vision, visual hallucinations, diplopia and dyschromatopsia including xanthopsia (yellow vision), cyanopsia (blue vision) and chloropsia (green vision). Dyschromatopsia can remain asymptomatic and detected only by formal testing. The mechanism of ocular toxicity postulated to be Na+ K+ ATPase inhibition [37–39]. Most appropriate test to support a diagnosis of digoxin ocular toxicity is photopic and scotopic electroretinogram (ERG) seeking for b-wave-delayed implicit time and decreased b-wave amplitude.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
No scientific studies regarding the safety of cardiac glycosides in pregnant women have been published. Among 34 infants born after exposure to digitalis during the first trimester, the frequency of birth defects (2.9 percent) was not greater than that expected. Fetal digitalis toxicity has been reported but it was secondary to maternal overdose (Sherman and Locke, 1960). In this latter report, it is estimated that the mother ingested 8.9 mg of digitoxin, resulting in significant fetal toxicity and neonatal death. Very limited information supports the view that cardiac glycosides are probably safe for use during pregnancy at therapeutic doses.
Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
In patients with moderate symptoms of HF, in addition to sodium restriction, diuretics such as furosemide and afterload-reducing agents like hydralazine should be considered. Digitalis is safe during pregnancy and may be used to maximize contractility and control heart rate, but improved survival rates have not been shown.
Severe lactic acidosis due to excessive consumption of Cellucor C4 exercise supplement
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Jason Rajchgot, Mika Hamilton, David K. Wong, Sandra Fischer, Aleksandra Leligdowicz
The disclosure rates of herbal and dietary supplement use to health care providers is as low as 33%, yet as many as 19% of adults in the United States admit to using one of these products in the past year.9 Dietary supplements are not necessarily benign, leading to approximately 23,000 emergency department visits in the United States annually.10 Contamination and product substitution are widely reported. In a study of 44 herbal products available in North America, more than half contained DNA from plant species not listed on the label.11 Modern pharmaceuticals have also been reported as unlisted ingredients. For example, supposedly natural products for erectile dysfunction have been found to contain PDE-5 inhibitors like sildenafil.12 Sibutramine, an appetite suppressant withdrawn from many countries due to risk of cardiovascular events, has been found in numerous products marketed for weight loss.12 In 1997, two cases of digitalis toxicity were reported in the United States after ingestion of a contaminated herbal supplement marketed as a cleanse.13
A special case of hypertrophic cardiomyopathy with a differential diagnosis of isolated cardiac amyloidosis or junctophilin type 2 associated cardiomyopathy
Published in Acta Clinica Belgica, 2021
Sévérine De Bruijn, Xavier Galloo, Gilles De Keulenaer, Edgard A. Prihadi, Christiane Brands, Mark Helbert
Therapy is mainly supportive directed toward complications such as heart failure. The mainstay of treatment of heart failure concerns diuretics, most often loop diuretics, potentially in combination with thiazide diuretics and an aldosterone antagonist. Beta-blockers and calcium channel blockers (CCB) slow the heart rate and are therefore often poorly tolerated, as patients with restrictive heart disease often have fixed stroke volume and the cardiac output is highly dependent on the heart rate [37]. CCB has a negative inotropic effect that outweighs the beneficial effects of LV relaxation or afterload reduction, with even published case reports of sudden death after the administration of such therapies [38,39]. ACE-inhibitors and angiotensin receptor blockers are not the first choice because they can cause profound hypotension and exacerbation of heart failure, particularly in AL amyloidosis [40]. Rate control of atrial fibrillation is difficult as beta-blockers and CCB are poorly tolerated. Digitalis is contraindicated because it accumulates in the amyloid deposition, leading to unpredictable and possibly toxic circulation concentrations [41]. Most effects have been accomplished with amiodarone, which is relatively well tolerated. Moreover, anticoagulation should be started because of the high thromboembolic risk.
Cardiotonic steroids as potential Na+/K+-ATPase inhibitors – a computational study
Published in Journal of Receptors and Signal Transduction, 2019
Chirag N. Patel, Sivakumar Prasanth Kumar, Krunal M. Modi, Mehul N. Soni, Nainesh R. Modi, Himanshu A. Pandya
Na+/K+-ATPase is a membrane-inserted enzyme which contains the single subunit of Cardiotonic steroids (CTS) or cardiotonic glycosides molecule [8–10]. The treatment of congestive heart failure is mediated by these compounds as positive inotropic agents [11]. For heart failure medication, various foxglove Digitalis plant phytochemicals were chosen in the initial studies [12,13]. A case study of cancer in 20th century suggested that the heart disease patients who utilized the CTS died reflectively [14]. The CTS have become the most popular anti-cancer agents for cancer treatments over the last 10 years. Flasch and Heinz has determined the effect of cardenolides and correlated its activity upon Na+/K+-ATPAse in papillary muscles of Guinea pig [15]. The metabolic transformation of various CTS compounds have been hypothesized as involvement of CTS into the evolution of cancer [16].