Digitalis Intoxication [antikvár]

PREFACE Although digitalis has been extensively used in our medical practice for the past two centuries, it is quite surprising that this is the first monograph entitled Digitalis Intoxication to appear in the world literature. The purpose of this monograph is to discuss in depth the entity of digitalis toxicity. The discussion is oriented toward practical clinical medicine in conjunction with the physiological and pharmacological aspects of the cardiac glycosides. Therefore, purposely detailed descriptions of the chemistry, metabolism and experimental studies regarding digitalis are only briefly discussed. Digitalis is without question the essential and the most valuable drug in the treatment of various heart diseases and rapid supraventricular arrhythmias. As with practically all valuable drugs, toxic effects will be manifested if the patient receives an excessive amount of the drug, or if the patient is unable to handle the drug properly. Digitalis, with its exceedingly narrow therapeutic and toxic dosage schedule, is certainly one of the most well known medications which typify this last statement. Among a multitude of host responses, the most important and frequent manifestation of this drug is the precipitation of digitalis-induced cardiac arrhythmias. These arrhythmias not only frequently aggravate pre-existing congestive heart failure, but may also quickly lead to death unless treated promptly and properly. Accordingly, digitalis-induced arrhythmias are fully discussed in all aspects. A-V nodal arrhythmias are discussed in detail, particularly because of their common occurrence and somewhat more difficult interpretation when viewing the totality of digitalis intoxication. A-V dissociation is included in this monograph to emphasize its clinical importance and to clarify the very confusing nomenclature in the world literature concerning this subject. Some of the rarer arrhythmias, such as parasystole and atrial dissociation, are also discussed because they may be frequently confused with digitalis-induced arrhythmias. A discussion of the Wolff-Parkinson-White syndrome is included since this syndrome is almost always associated with very rapid supraventricular arrhythmias which may be intractable to ordinary digitalis therapy. Some of the vii