摘要:

SummaryThe author summarises shortly the myocardial metabolism and afterwards he comments the influence of digitalis and analogue compounds on normal and failing heart, high energy phosphate, contractile proteins, relaxing factor and ions migration through the myocardium.

ISSN:1784-3286    

DOI:10.1080/17843286.1963.11717148

出版商:Taylor&Francis    

年代:1963

数据来源: Taylor

摘要:

SummarySeveral parameters have been proposed as objective criteria to differentiate compensated from uncompensated heart insufficiency : diastolic or systolic ventricular pressure, systolic stroke volume, heart output, diastolic or systolic residual volume. Data obtained in normal as well as in ill individuals show that, for each of those parameters considered individually, there are cases of heart insufficiency clinically uncompensated with normal values, which lead to erroneous clinical judgment.On the other hand, the correlation between diastolic ventricular volume and resistance to ventricular ejection allows clear distinction between compensated and uncompensated myocardial insufficiency. In normal subjects or in compensated heart insufficiency, experimental data fall on a hyperbole. Contrastingly, all cases of uncompensated heart failure, secondary to excessive pressure as well as to excessive volume, are situated outside of the hyperbole. During digitalization, aberrant points tend to go back into the normal zone. At the present state of our knowledge, the ratio diastolic ventricular volume/systolic resistance to ventricular ejection seems to constitute the best criterion for the differentiation of uncompensated from compensated heart failure.

ISSN:1784-3286    

DOI:10.1080/17843286.1963.11717149

出版商:Taylor&Francis    

年代:1963

数据来源: Taylor

摘要:

SummaryThrough their inhibitory action on conduction and changes they produce on myocardial excitability, cardiotonic glucosides play a leading part in the treatment of many disturbances of heart rhythm. Ventricular tachycardia and auriculo- ventricular block constitute the only classical contra-indications to their use Their direct cardiotonic effects are always desirable when arrhythmia induces heart failure.1)In auricular flutter,digitalis is essential; it is the only drug to restore sinus rhythm in more than half of the cases. Dosage should be large enough to impregnate heart muscle correctly. The only contra-indication is flutter with very slow ventricular rhythm or with conduction disturbances. Digitalis is the treatment of choice in the prevention of recurrences.2)Inpermanent auricular fibrillation,digitalis is indicated for the control of ventricular rhythm when quinidinc is contra-indicated or has failed. Although anticoagulant therapy must often be associated with digitalis, cardiotonic glucosides are usually better tolerated than quinidine in chronic cases. Their place in the treatment of paroxystic tachycardia is less important for they tend to maintain this type of arrhythmia.3)In supraventricular tachycardia,when active intervention is mandatory, digitalis constitutes a safe therapy, which is probably more efficient than peroral quinidine treatment, and less dramatic than cholinergic drugs. Chronic digitalization efficiently prevents recurrences. Digitalis is strongly advocated in supraventricular tachycardia in infants and children.4)Ventricular tachycardiaconstitutes classical contra-indication to the use of digitalis, except in very rare cases, where other drugs have failed.5)Auriculo-ventricular blocksare also contra-indications, unless heart failure has supervened. In such cases, digitalis therapy should he carefully supervised.6)Digitalis induced arrhythmiasrequire interruption of treatment.The use of digitalis in cardiac arrhythmias necessitates regular clinical and electrocardiographic supervision, usually in specialized environment, with sometimes the addition of K or antifibrillating agents, and the choice between the various glucosides. Their handiness and efficiency, in function of precise indications, constitute the main qualities of these often irreplaceable drugs.

ISSN:1784-3286    

DOI:10.1080/17843286.1963.11717150

出版商:Taylor&Francis    

年代:1963

数据来源: Taylor

摘要:

SummaryPresent knowledge on the electrical activity of the myocardial cell and the transmembrane ionic fluxes is summarized.. The effects of experimental variations of plasma levels of K, Na and Ca on the activity of digitalis glucosides arc recalled.Clinical illustrations of the interaction between digitalis and 1) hypokalæmia, 2) hyperkalæmia, 3) hypernatræmia are presented.Abolition of glucoside toxictiy by K salts, even at normal plasma K concentration, is illustrated.

ISSN:1784-3286    

DOI:10.1080/17843286.1963.11717151

出版商:Taylor&Francis    

年代:1963

数据来源: Taylor

摘要:

SummaryThe termdigitalic impregnationhas been used to characterize the effects, clinical as well as electrocardiographic, induced by digitalis treatment. However, in view of the present data of the literature, a more limited significance should be attributed to it, taking into account the balance between digitalis administration to a patient and its inactivation in the body, this balance ensuring the maintenance of an efficient level of the tonicardiac in the organism. On the other hand, when the requisite level is higher than the inactivation rate by the organism, the drug accumulates in the body; if this accumulation exceeds a certain level, varying from one individual to another, intoxication symptoms appear.The variability between therapeutic and toxic doses front one individual to another, have made it imperative to undertake tentative research to determine the requisite level. As far as these drugs are concerned, there is practically no therapeutic effect without risk of toxicity. If toxic manifestations vary from one patient to another, and are characterized either by digestive, neuro-sensitive or cardiac disturbances, or by the association to varying degrees of these various disorders, all preparations of toni-cardiac drugs, however, can involve the same fundamental clinical manifestations. The initial onset of toxic symptoms wouldbe different, in the case of acute and massive intoxication, from those of therapeutic intoxication. Schematically, during the former, digestive symptoms appear very early, soon followed by nervous disorders and finally by cardiac disturbance whereas in the latter, arrhythmia and digestive and neurologic disturbances seem to appear simultaneously.Whatever the case may be, digitalis toxocity is fundamentally characterized by these three kinds of accidents, among which rhythm disturbances are the gravest in view of the risks of lethal collapse they may entail.Prognosis is variable. It does not seem to depend on the ingested dose, but rather on the state of the organism and more particularly on the cardiac and renal states. As a proof, we can mention the prognosis, benign on the whole, of intoxications in the child and in the adult with normal heart. Thrombo-embolic and infectious complications will of course weigh heavily on the prognosis.

ISSN:1784-3286    

DOI:10.1080/17843286.1963.11717152

出版商:Taylor&Francis    

年代:1963

数据来源: Taylor