TY - JOUR
T1 - Current concepts and treatment of digitalis toxicity
AU - Mason, Dean T.
AU - Zelis, Robert
AU - Lee, Garrett
AU - Hughes, James L.
AU - Spann, James F.
AU - Amsterdam, Ezra A.
N1 - Funding Information:
From the Section of Cardiovascular Medicine, Departments of Medicine, Physiology and Pharmacology, University of California at Davis, School of Medicine, Davis, Calif. and the Sacramento Medical Center, Sacramento, Calif. This work was supported in part by Training Grants HE-5877.and HE-5901 and Research Fellowship Award HE-48679 from the National Heart and Lung Institute, National Institutes of Health, Bethesda, Md.
PY - 1971/5
Y1 - 1971/5
N2 - Digitalis toxicity is among the most common adverse drug reactions, and may cause arrhythmias and conduction disturbances in as many as 1 of 5 patients. Particularly responsible are the electrophysiologic properties of digitalis in increasing the automaticity of subsidiary pacemakers, reducing the refractory period and prolonging conduction velocity in the atria and ventricles, and delaying conduction in the atrioventricular (A-V) node. Underlying these electrophysiologic effects are digitalis-influenced alterations of cardiac cell transmembrane movements of sodium and potassium; the induction of ectopic impulses due to increased automaticity appears to be caused by inhibition of the activity of the sodium-potassium membrane adenosine triphosphatase (ATPase) pump. Digitalis can provoke every type of cardiac arrhythmia, and no specific disorder of rhythm can be considered absolutely pathognomonic of digitalis toxicity. The factors that predispose to digitalis toxicity, as well as the onset and duration of action of the agent, must be taken into account. Potassium has relatively little influence on the toxic and the contractile actions of digitalis when the cation is administered after the glycoside has been taken up by the myocardium. In contrast, alterations in serum potassium effected before treatment with digitalis may have drastic effects on the electrophysiologic and contractile actions of the glycoside; hyperkalemia reduces the binding of digitalis to the myocardium. Diphenylhydantoin, lidocaine and propranolol are effective in terminating digitalisprovoked tachyarrhythmias, usually without inducing or worsening A-V block. Atrial or ventricular pacing to achieve electrical overdrive of the ectopic focus may be used if standard measures fail. In complete heart block, potassium should not be administered; atropine and electrical pacing should be used.
AB - Digitalis toxicity is among the most common adverse drug reactions, and may cause arrhythmias and conduction disturbances in as many as 1 of 5 patients. Particularly responsible are the electrophysiologic properties of digitalis in increasing the automaticity of subsidiary pacemakers, reducing the refractory period and prolonging conduction velocity in the atria and ventricles, and delaying conduction in the atrioventricular (A-V) node. Underlying these electrophysiologic effects are digitalis-influenced alterations of cardiac cell transmembrane movements of sodium and potassium; the induction of ectopic impulses due to increased automaticity appears to be caused by inhibition of the activity of the sodium-potassium membrane adenosine triphosphatase (ATPase) pump. Digitalis can provoke every type of cardiac arrhythmia, and no specific disorder of rhythm can be considered absolutely pathognomonic of digitalis toxicity. The factors that predispose to digitalis toxicity, as well as the onset and duration of action of the agent, must be taken into account. Potassium has relatively little influence on the toxic and the contractile actions of digitalis when the cation is administered after the glycoside has been taken up by the myocardium. In contrast, alterations in serum potassium effected before treatment with digitalis may have drastic effects on the electrophysiologic and contractile actions of the glycoside; hyperkalemia reduces the binding of digitalis to the myocardium. Diphenylhydantoin, lidocaine and propranolol are effective in terminating digitalisprovoked tachyarrhythmias, usually without inducing or worsening A-V block. Atrial or ventricular pacing to achieve electrical overdrive of the ectopic focus may be used if standard measures fail. In complete heart block, potassium should not be administered; atropine and electrical pacing should be used.
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U2 - 10.1016/0002-9149(71)90418-8
DO - 10.1016/0002-9149(71)90418-8
M3 - Article
C2 - 4252303
AN - SCOPUS:0015057112
SN - 0002-9149
VL - 27
SP - 546
EP - 559
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 5
ER -