Chronic digoxin toxicity and significantly elevated BNP levels in the presence of mild heart failure

K, Heinrich; Prendergast, Heather M.; Erickson, Timothy

doi:10.1016/j.ajem.2004.10.009

Cited by 9 publications

(3 citation statements)

References 2 publications

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“…Other drugs like the diuretics in addition to the aforementioned reduce NP levels; hence, many patients with chronic stable HF have been reported to have BNP levels within the normal range of <100 pg/mL 6,8,9. Digoxin and β-blockers however increase NP levels 6,9,30,31. The increase from β-blocker therapy occurs initially, as it blocks the adrenergic stimulation that acts to decrease BNP release, with subsequent decline in BNP levels in the long term 31.…”

Section: Discussionmentioning

confidence: 99%

<p>B-Type Natriuretic Peptides (BNP) and Tissue Doppler E/e´ Before and After 4 Weeks Standard Treatment of African Heart Failure Subjects: The ABU-BNP Longitudinal Survey</p>

Onyemelukwe

Oyati

Danbauchi

et al. 2019

VHRM

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BackgroundThe study aimed at determining the response of BNP and tissue Doppler (TD) E/e´ to standard heart failure (HF) therapy in an African black population as data on these are lacking in Africa. BNP assessment in relation to HF severity and its association with its predictors were also determined.MethodsIt was a longitudinal-analytical study with a one month follow-up among 100 HF patients seen at Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. Two-way Repeated Measures ANOVA determined BNP levels before and after treatment according to the HF severity. Wilcoxon-Signed Ranks test determined the difference in BNP and TD E/e´ before and after treatment. Pearson’s correlation assessed log-transformed BNP’s association with its predictors.ResultsBNP significantly (p<0.001) rose with increasing severity of HF from 386.6 ± 186.5 pg/mL to 581.7 ± 299.0 pg/mL to 805.0 ± 484.0 pg/mL in the NYHA II-IV HF, respectively, with consequent fall in a similar fashion following treatment. The Median (IQR) BNP levels reduced significantly (p<0.001) from 450 (362.5, 712.5) to 275.0 (225, 375.2) pg/mL with a 38.9% reduction over 4 weeks associated with significant improvement in TD E/e´, structural and functional parameters. Ln10BNP was significantly (p<0.001) positively correlated to TD E/e´ before (r=0.51) and after treatment (r=0.43). Likewise, Ln10BNP was significantly (p<0.05) negatively correlated to ejection fraction & fractional shortening before and after treatment.ConclusionBNP and tissue Doppler can serve as useful tools in the assessment of the effectiveness of African HF treatment and functional capacity over 4 weeks. TD E/e´ may be a reliable non-invasive estimate of left ventricular filling pressures and diastolic dysfunction.

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Section: Discussionmentioning

confidence: 99%

<p>B-Type Natriuretic Peptides (BNP) and Tissue Doppler E/e´ Before and After 4 Weeks Standard Treatment of African Heart Failure Subjects: The ABU-BNP Longitudinal Survey</p>

Onyemelukwe

Oyati

Danbauchi

et al. 2019

VHRM

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“…4 Such cases can be associated with acute deterioration of left ventricular systolic dysfunction (LVSD) and respond well to treatment with digibind. 5 Furthermore, an article in Clinical Toxicology reports cases from south-east Asia where another plant with high levels of cardiac glycosides, the Yellow oleander, is frequently taken for the purposes of deliberate self-harm. 6 In such cases, patients typically present with hyperkalaemia and an important part of the treatment is the administration of digoxin-specific antibody fragments.…”

Section: Discussionmentioning

confidence: 99%

Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia

2011

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We report a previously healthy man presenting with life-threatening hyperkalaemia and heart failure. The only possible cause was thought to be the long list of herbal medications he was taking, several of which contained significant amounts of cardiac glycosides. Hyperkalaemia is known to be associated with digoxin toxicity and we present this as the likely cause in this case, and emphasize the importance of a thorough drug history in forming a differential diagnosis.

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“…Digoxin increases plasma BNP levels by increasing cardiac contractility and causing BNP production within the myocardium. 82 A placebocontrolled study of 25 patients with heart failure demonstrated a significant increase in mean plasma BNP concentration with digoxin compared with placebo at 3 hours (227.1 vs 130.0 pg/ml, p<0.01), 3 days (223.7 vs 130.0 pg/ml, p<0.01), and 6 days. 83 Another small placebo-controlled trial of patients with heart failure showed a significant increase compared with placebo in plasma BNP concentration 1 hour after intravenous administration of digitalis (mean ± SD 628 ± 116 vs 689 ± 132 pg/ml, p<0.05) despite a significant decrease in pulmonary capillary wedge pressure (19.7 ± 2.3 vs 16.8 ± 2.3 mm Hg, p<0.05).…”

Section: Effects Of Heart Failure Drugs On Concentrationsmentioning

confidence: 99%

Serial Monitoring of Brain Natriuretic Peptide Concentrations for Drug Therapy Management in Patients with Chronic Heart Failure

2008

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Heart failure is a major problem in the Unites States. Despite the availability of and increasing adherence to evidence-based guidelines, the morbidity and mortality from this disease remain significant. Strides have been made in the last several years to develop objective tools to aid in the diagnosis of heart failure and in the prognosis of the affected patients. Brain natriuretic peptide (BNP) and the N-terminal prohormone of BNP are neurohormones released in response to ventricular wall stress and/or tension. As objective laboratory measures, both peptides have similar utility in the treatment of patients with heart failure. Currently, these laboratory tests are approved only to aid in diagnosis. However, data are beginning to emerge that suggest the utility of serial BNP monitoring for the management of chronic heart failure in patients with left ventricular dysfunction. Preliminary studies have shown that when added to traditional management combined with adherence to evidenced-based national guidelines, serial monitoring of BNP levels with adjustment of therapy based on the results may improve outcomes in patients with chronic heart failure compared with traditional clinical management alone. Factors that may limit the use or confound interpretation of the laboratory test results include the effects of demographics (e.g., sex, age, body mass index), concurrent diseases, and drug therapies. Several large, outcomes-based studies are under way to examine the use of serial BNP monitoring to decrease morbidity, mortality, and overall health care costs in patients with heart failure.

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Chronic digoxin toxicity and significantly elevated BNP levels in the presence of mild heart failure

Cited by 9 publications

References 2 publications

<p>B-Type Natriuretic Peptides (BNP) and Tissue Doppler E/e´ Before and After 4 Weeks Standard Treatment of African Heart Failure Subjects: The ABU-BNP Longitudinal Survey</p>

<p>B-Type Natriuretic Peptides (BNP) and Tissue Doppler E/e´ Before and After 4 Weeks Standard Treatment of African Heart Failure Subjects: The ABU-BNP Longitudinal Survey</p>

Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia

Serial Monitoring of Brain Natriuretic Peptide Concentrations for Drug Therapy Management in Patients with Chronic Heart Failure

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