Studies on the Dosage of Digitalis in Children

McCulloch, Hugh; Rupe, Wayne A.

doi:10.1097/00000441-192108000-00010

Cited by 16 publications

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“…The discussion of pediatric cardiologists has been focused for nearly 100 years on the question whether digitalis should be used or not. The first reports on the effects of digitalis in children are published 1921 [12]. AS Nadas et al published the use of digitalis in 41 infants and children 1953 in the New England Journal of Medicine and conclude: "obviously the groups responding best were the patients with myocardial disease, paroxysmal tachycardia and rheumatic disease" and "…the patients with congenital heart disease, among whom therapeutic failures were numerous" [13].…”

Section: The Digoxin Discussionmentioning

confidence: 99%

Heart Rate Variability in Heart Failure

Moore¹,

Nolan²

2004

Dynamic Electrocardiography

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Heart failure is one of the main causes of death in infants with and without congenital heart disease and has long term consequences in surviving infants, such as impaired linear growth, worse neurodevelopmental outcomes and an enhanced cardiovascular mortality. Current pharmacotherapy is not proven by prospective randomized trials. We use online monitoring of heart rate variability (HRV) to measure the effect of pharmacotherapy on the autonomic nervous system. Methods:The infants are routinely monitored with Dräger Infinity Monitors™ (Dräger; Germany) on our pediatric intensive care unit. For analysis of heart rate variability, we export the monitor data to the Pathfinder™ ECG Software using a network connection. 7 clinical cases are discussed.Results: Infants with a high frequency power in the spectral analysis of heart rate variability below 20ms had a high risk to die from heart failure ± inflammation. Propranolol but not metoprolol improves HRV, NT-Pro BNP and troponin T values. We anticipate a further improvement of HRV in 2 cases with an additional digoxin treatment. Conclusion:Reduced HRV seems to be an important risk factor for life threatening complications in infants with severe heart failure and should be monitored in infants with severe heart failure. Propranolol but not metoprolol improves HRV. Additional digoxin further improves HRV in two cases treated with propranolol.These preliminary results have to be proven by prospective trials using HRV analysis for risk stratification.

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Section: The Digoxin Discussionmentioning

confidence: 99%

Heart Rate Variability in Heart Failure

Moore¹,

Nolan²

2004

Dynamic Electrocardiography

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Digitalis Therapy in Cardiac Decompensation in Children

Jacobsen¹

1926

Arch Pediatr Adolesc Med

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Digitalis is often believed to be ineffectual in the treatment of cardiac disease in children. The most probable explanation for this belief is that the doses commonly used have been too small, for McCulloch and Rupe 1 have demonstrated that both normal children and those suffering from heart disease require from 10 to 100 per cent more digitalis per pound of body weight than do adults before electrocardiographic or other signs of digitalization are produced. Our studies of twenty-six children suffering from severe myocardial failure confirm this report, and lead us to the conclusion that even larger doses are beneficial in causing a loss of edema and an increase in the patient's comfort. Digitalis will not, of course, repair the myocardial damage, but a comparison between the fate of children treated with the drug and that of those who did not receive it would seem to indicate that the administration of digitalis will to some extent prolong life by providing an opportunity for compensation. MATERIAL These twenty-six patients (table 1) suffered from rheumatic endocarditis and myocarditis, and represent all the cases of severe cardiac decompensation admitted to this hospital from 1921 to 1926. All were orthopneic and edematous, and half of them (thirteen) had marked ascites. None of the cases of rheumatic endocarditis in which the symptoms of decompensation were absent or slight were included. These children were from 3 to 13 years of age, and had had their first attack of acute rheumatic fever or chorea from three months to five years previously. Of these twenty-six patients, twenty-one had had rheumatic fever, in some instances chorea also, and the remaining five had had chorea alone. Symptoms and signs of heart disease had been present from three to thirty months before decompensation developed.

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Digitalis Studies on Children With Heart Disease

Schwartz¹

1929

Am J Dis Child

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The purpose of this study was to determine the effects of digitalis on the electrocardiograms of children with rheumatic heart disease and signs of heart failure. It has been shown by Cohn and his co-workers 1 that an alteration in the size, shape and direction of the T wave of the electrocardiogram is the earliest index of digitalis action. This may take place before disturbances in rhythm and conduction time have occurred and before the patient exhibits any minor toxic manifestations, such as nausea and vomiting. The changes in the electrocardiogram consist essentially in a progressive diminution of the size of the T wave in either one or all three leads, with final inversion of previously upright waves. In cases yielding downwardly directed T waves before the use of digitalis, the drug produces eventually upwardly directed waves. These variations have found ample support in subsequent clinical and experimental observations on both man and animals.2 In children, however, a similar systematic study of the effects of digi¬ talis on the electrocardiogram has not been carried out with any degree of accuracy. Since the optimal dosage of digitalis and its value and limitations in children with heart disease are still mooted questions,3

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Studies on the Dosage of Digitalis in Children

Cited by 16 publications

References 0 publications

Heart Rate Variability in Heart Failure

Heart Rate Variability in Heart Failure

Digitalis Therapy in Cardiac Decompensation in Children

Digitalis Studies on Children With Heart Disease

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