The Use of Digitalis in Infants and Children

Digitalis toxicity in infants and children

“…Adults or children with severe heart disease are also more susceptible [4,29,45] because of the altered characteristics of the myocardium, loss of contractile tissue mass, and/or a low cardiac output state with accumulation of the glycoside in the body. Of the electrolyte disturbances, the most serious is hypokalemia, which is frequently associated with chronic and prolonged diuretic therapy.…”

“…Nausea and vomiting may be protracted, frequently recurrent, and represent the major extra cardiac symptom complex of digitalis toxicity. They are frequently the earliest manifestations of digitalis toxicity and occur in 75% of adults and older children [4,29]; they are less prevalent in infants and small children [29,45]. Abdominal pain, attributed to mesenteric arterial ischemia, may be prominent.…”

“…A combination of arrhythmias may exist in any patient, and the heart failure may be worsened. Certain types of rhythm disturbances are especially prevalent in both adults and children [4,16,29,45,48,63]. They include ectopic atrial or atrioventricular (AV) junctional (supraventricular) tachycardias, which may be paroxysmal, are often associated with varying degrees of AV block, sometimes with variable block, and with or without atrioventricular dissociation.…”

False "Coronary Patterns" in the Infant Electrocardiogram

“…23 We are aware that electrocardiographic changes of the type illustrated in figures 4 and 5 are at variance with the usual effects of digitalis in adults26-29 as well as in children and infants. [30][31][32] Ordinarily the S-T deviations develop in a direction opposite to, rather than parallel to, the main QRS de-flection, in keeping with experimentally produced lesions in the subendocardium. 33' 34 However, in some of these experiments, S-T elevations of the type discussed were produced when the animals were exposed to toxic doses of digitalis.35…”

Age-Related Changes in Electrophysiological Properties of Canine Purkinje Fibers: Effect of Ouabain

“…An increased tolerance of infants and young children to digitalis glyco sides is well documented [8,15,16]. This has been confirmed experimen tally in the intact guinea pig [25] and dog [10].…”