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Intra-cellular electrolyte changes and levels of endogenous digoxin-like substance within the plasma in patients with
1Department of Cardiovascular Medicine, First Teaching Hospital of Xi'an Medical University, P.R. China.
Insights
Elevated endogenous digoxin-like substance in heart failure patients correlates with electrolyte imbalances and reduced Na/K-ATPase activity. Non-digitalis therapy improved these markers, suggesting a role for this substance in congestive heart failure pathophysiology.
Area of Science:
- Cardiology
- Biochemistry
- Cellular Physiology
Background:
- Chronic congestive heart failure (CHF) is associated with complex physiological alterations.
- Electrolyte balance and membrane transport are critical for cardiac function.
Purpose of the Study:
- To investigate the relationship between intracellular electrolytes, endogenous digoxin-like substance (EDLS), and Na/K-ATPase activity in CHF patients.
- To explore the potential role of EDLS in CHF-related electrolyte disturbances.
Main Methods:
- Analysis of intracellular potassium, sodium, calcium, and magnesium in lymphocytes and erythrocytes from 50 CHF patients and 39 controls.
- Measurement of plasma EDLS levels and red blood cell membrane Na/K-ATPase activity.
- Correlation analysis between electrolyte levels, EDLS, and Na/K-ATPase activity.
Main Results:
- CHF patients exhibited decreased intracellular potassium and magnesium, and increased intracellular sodium and calcium.
- Plasma EDLS levels were significantly elevated in CHF patients compared to controls.
- Na/K-ATPase activity was significantly lower in CHF patients, correlating with higher EDLS levels.
Conclusions:
- Endogenous digoxin-like substance may contribute to the intracellular electrolyte imbalance observed in congestive heart failure.
- Therapeutic interventions not involving digitalis led to recovery of electrolyte balance and improved Na/K-ATPase activity, with decreased EDLS levels.
- Digoxin therapy could potentially worsen intracellular potassium loss in CHF patients.
Abstract:
In this study, the lymphocytes and erythrocytes from peripheral venous blood were used as the study model from which were measured the cellular contents of potassium, sodium, calcium and magnesium in 50 patients with chronic congestive heart failure and 39 control patients. Levels of endogenous digoxin-like substance in the plasma and activities of Na/K ATPase in red cell membrane wer monitored simultaneously. In the patients with heart failure, the intracellular contents of potassium and magnesium were decreased while those of sodium and calcium were increased significantly. The levels of endogenous digoxin-like substance were much higher in the plasma than those either in healthy controls or in patients with heart disease but without congestive failure (273.7 +/- 35.5 vs 23.3 +/- 2.2 and vs 32.9 +/- 3.6 pg/ml, respectively, P less than 0.001 for both). The activities of Na/K-ATPase were much lower in the patients with heart failure than in the controls. Values for intracellular electrolytes were significantly correlated with the rising levels of digoxin-like substance in the plasma. Non-digitalis inotropic therapy was associated with the recovery of these alterations of heart function, with the levels of the digoxin-like substance decreasing and activity of Na/K-ATPase going up. We conclude that endogenous digoxin-like substance might play a role in the imbalance of intra-cellular electrolytes seen in patients with congestive heart failure. Digoxin may exacerbate the loss of intracellular potassium.