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[Rhythm and conduction disorders caused by cardiac glycosides]
Insights
Cardiac glycoside toxicity can cause significant heart rhythm and conduction disorders in patients. Ventricular extrasystoles and AV block are common, with a small but notable risk of fatality from ventricular fibrillation.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Context:
- Cardiac glycosides are widely used for heart conditions.
- Patient monitoring for adverse effects is crucial.
- Understanding the incidence of toxicity is important for patient safety.
Purpose:
- To investigate the incidence and types of cardiac rhythm and conduction disorders associated with cardiac glycoside use.
- To identify risk factors for cardiac glycoside intoxication.
Summary:
- Cardiac glycosides can induce various rhythm and conduction disorders in 19.1% of patients.
- Ventricular extrasystoles (47%) and AV block (23.4%) were the most frequent, with a 0.89% lethality rate from ventricular fibrillation.
- Intoxication risk is higher in patients with severe myocardial lesions, rheumatic activity, decompensation, and those on potent diuretics, predisposing to hypokalemia.
Impact:
- Highlights the significant risk of cardiac arrhythmias with cardiac glycoside therapy.
- Informs clinical practice regarding patient selection and monitoring.
- Emphasizes the role of hypokalemia in potentiating digitalis toxicity.
Abstract:
Cardiac glucosides could cause almost all kinds of rhythm and conduction disorders. In 648 patients treated with cardiac glucosides, rhythm and conduction disorders were recorded in 124 patients--19.1 per cent (58 males and 60 females), aged from 17 to 76. Ventricular extrasystoles rank first according to incidence--47 per cent; ventricular bigeminy--24.3 per cent; AV block stage I--23.4 per cent, etc. From all the 124 patients registered with intoxications induced by cardiac glucosides--one patient died, very likely due to ventricular fibrillation--0.89 per cent lethality. Toxic symptoms with initial saturation with digitalis preparation is most frequently observed in patients with grave myocardial lesions as well as rheumatic activity, accompanied by cardiac decompensation and a parallel administration of potent diuretic treatment that favours hypopotassemia and glucoside intoxication.