Basic principles of treatment of acute poisoning with cardiac glycosides. Poisoning with cardiac glycosides: help, symptoms, treatment

Cardiac glycoside poisoning can occur with an overdose of these potent drugs. More often, an overdose of cardiac glycosides develops with the simultaneous treatment of heart failure with diuretic drugs.

First urgent care in case of poisoning with cardiac glycosides, symptoms and treatment.

Signs of poisoning with cardiac glycosides appear when the minimum therapeutic dose is exceeded by only 2 times. Given the individual sensitivity of patients to drugs, the risk of overdose of cardiac glycosides is high. Exceeding the minimum therapeutic dose of cardiac glycosides by 5-10 times is fatal.

The most commonly prescribed glycoside for the treatment of heart disease is digoxin. Its absorption and distribution to tissues in the body is slow, it gradually accumulates in muscle tissue and liver. With violations of the functions of the kidneys and liver, its excretion from the body slows down even more and the likelihood of poisoning increases. Therefore, cardiac glycosides are prescribed only under the supervision of a physician and their doses are adjusted during treatment. Patients with an overdose of cardiac glycosides or poisoning with them need emergency care.

Symptoms of poisoning with cardiac glycosides.

In case of poisoning with cardiac glycosides, vomiting appears, consciousness is disturbed (confusion), then it is lost, there may be convulsions. Visual disorders develop - vagueness of visible objects, impaired color perception, fear of light, loss of visual fields. Toxic damage to the heart is manifested by disturbances in the rhythm of its contractions, a decrease in frequency, atrioventricular blockade. In acute poisoning, on the contrary, there is an increase heart rate a decrease in the level of potassium in the blood.

Emergency care for poisoning with cardiac glycosides.

In case of poisoning with cardiac glycosides, these drugs are canceled. Do not induce vomiting or give emetics, as this may adversely affect cardiac activity. It is necessary to wash the stomach through a tube. Give to the victim Activated carbon and a saline laxative (15–30 g sodium sulfate). Activated charcoal is also given in the future, it helps to remove cardiac glycosides, not only in the intestines, but also contained in the blood.

Intramuscularly injected 5% unithiol solution (5 ml 4 times a day) and 30% solution of tocopherol acetate (vitamin E) - 2 ml per day. Of the glucocorticosteroid drugs, hydrocortisone is used (intramuscularly administered at 125 mg 3 times a day). If a frequent pulse is noted against the background of poisoning, then drugs such as a 20-25% solution of magnesium sulfate, a solution of lidocaine (1-3 mg / kg of body weight), phenytoin (according to the scheme) are administered.

When the pulse slows down, 1 ml of a 0.1% solution of atropine sulfate is injected subcutaneously. It is possible in this case to use isoprenaline hydrochloride intravenously (0.05–2 μg / kg of body weight per minute), antidigoxin. Last drug administered intravenously slowly over 30 minutes, with cardiac arrest - in a stream. To neutralize 0.6 mg of digoxin, 40 mg of antidigoxin is required.

With atrial fibrillation (very frequent ineffective heart contraction) 5 ml of a 10% solution of novocainamide is injected intravenously. Infusion therapy in the mode of forced diuresis and hemodialysis are ineffective in case of poisoning with cardiac glycosides. Hemosorption can give a positive result.

Poisoning with opiates, substances and drugs of narcotic action.

Opiates include substances and narcotic drugs derived from opium (morphine, heroin, codeine, promedol, and others). With an overdose of these substances, inhibition of the cerebral cortex, depression of the respiratory and cough centers, and excitation of the vomiting center of the brain occur.

Symptoms of poisoning with opiates, substances and drugs of narcotic action.

First, a deep sleep develops, which gradually turns into. There is a lack of consciousness and pain sensitivity. Pronounced blue skin, sweating. Body temperature is reduced. Breathing becomes shallow, then irregular. The pulse slows down. Arterial pressure decreases. Pulmonary edema often develops. The pupils are very narrowed, look like dots, do not react to light.

First emergency aid in case of poisoning with opiates, substances and drugs of narcotic action.

It is necessary to turn the head of the victim to one side to prevent leakage of the contents of the stomach into Airways. Provide access to fresh air. Urgently call an ambulance. Conduct activities as needed. The doctor inserts a breathing tube into the trachea and a probe into the stomach. Then the stomach is thoroughly washed, preferably with a weak (1: 2000) solution of potassium permanganate, and 100–150 ml of a 33% solution of magnesium sulfate is injected into the stomach. After that, diuretics (furosemide) are administered.

All victims are inhaled with humidified oxygen, intravenously injected with a solution of sodium bicarbonate. In case of poisoning with opiates, antagonists - naloxone hydrochloride or nalorphine hydrochloride - are administered intravenously, intramuscularly or subcutaneously. The initial dose for adults is 400 micrograms, for children - 5-10 micrograms / kg of body weight. After 3-5 minutes, if necessary, the drug is administered again.

Based on the book "Quick help in emergency situations."
Kashin S.P.

Cardiac glycosides belong to the group medicines required for the treatment of heart failure. Course or single use of these drugs ensure the effective functioning of the heart, positively affecting the condition and functioning of the myocardium.

Intoxication with cardiac glycosides is explained by certain characteristics of these drugs, which contribute to the accumulation of the drug in the body and can cause serious pathological changes.

Cardiac glycosides are prescribed according to strict indications. In this group there are drugs that have an instant therapeutic effect, and they are used to relieve acute conditions.

Other types of cardiac glycosides are prescribed for long-term treatment, during which their dose adjustment should be carried out constantly.

Causes of glycoside intoxication

Glycoside intoxication most often occurs in patients using these drugs for the treatment of heart disease. Less commonly, this condition develops in people taking the drug for the purpose of suicide, even more rarely, an overdose occurs with the accidental use of plants containing glycosides.

Intoxication with glycosides occurs when the dosage of these drugs is exceeded. A lethal outcome can be observed if a single dose is 5-10 times higher than the prescribed therapeutic one.

Sensitivity to cardiac glycosides increases with certain diseases and conditions of the body, this group of provoking factors includes:

When prescribing cardiac glycosides, the doctor should carefully study the history and only then select the required dosage.

Intoxication with cardiac glycosides may begin to develop several weeks after the first dose. A glycoside such as digoxin, used for treatment in the elderly, has a tendency to accumulate in the body. Therefore, its dose after treatment for several days should be adjusted downwards.

In older people, an overdose often occurs due to their memory problems, and therefore relatives should control the intake of glycosides in old age.

Signs of an overdose

Glycoside intoxication is manifested by a decrease in the number of heart contractions, extrasystole, damage to the gastrointestinal tract, which is expressed by nausea and vomiting.

Symptoms of intoxication consist of gastrointestinal, neuropsychiatric, cardiovascular syndrome, visual impairment also joins. Acute poisoning with cardiac glycosides can be suspected if the following symptoms are recorded:

Signs of rhythm disturbance - bradycardia, extrasystole, atrial fibrillation. Tachycardia that develops after bradycardia and a period of normal heart rate.
Symptoms of dysfunction of the digestive tract. This is manifested by nausea, abdominal pain, vomiting. With chronic overdose, anorexia develops.
Symptoms of CNS damage. Cardiac glycosides in a large dose lead to the development of hallucinations, depression, severe headaches and dizziness. Patients develop delirium, with chronic poisoning disturbing nightmares.

Acute poisoning affects the appearance of visual changes. You can pay attention to the drop in vision, the appearance of yellow and green spots when looking at an object. The patient is worried, he has cyanosis of the nasolabial triangle and lips, hypoxia, shortness of breath, in severe cases, convulsions and coma.

Intoxication with glycosides can also be detected after an ECG. On the cardiogram, the PQ interval is lengthened, a negative or flattened T wave is detected, and a disturbance in conduction and rhythm is noticeable.

development is considered dangerous ventricular extrasystole, atrial fibrillation. Death with an overdose of glycosides occurs due to cardiac arrest or asphyxia.

First aid for glycoside intoxication

If symptoms of intoxication with cardiac glycosides are recorded, then it is necessary to act according to the following scheme:

Cancel treatment with cardiac glycosides.
Conduct early detoxification and administration of specific antidotes.

In acute poisoning, early detoxification should be aimed at reducing the concentration of the drug in the stomach, for this purpose, the following is carried out:

Gastric lavage. In a hospital setting, a saline laxative and activated charcoal are injected through the probe, which will reduce the absorption of glycosides into the walls of the organ. If poisoning is known to have occurred with isolanide or digitoxin, then 200 ml of vaseline oil can be injected. This will reduce the circulation of drugs in the blood.
When vomiting, it is necessary to create conditions that prevent aspiration of vomit.
Glycoside poisoning requires the provision of medical care in a hospital, and therefore, when this condition is fixed, an ambulance is called immediately.

Treatment in the hospital includes the following activities:

The introduction of Unithiol, glucocorticosteroids, vitamin E. The dosage of these drugs is selected by the doctor.
The heart rate is normalized by antiarrhythmic drugs. The exception is novocainamide and quinidine. In the absence of the effect of these funds, defibrillation is performed.
The victim is provided with oxygen inhalations, a 5% glucose solution with insulin is injected.
When vomiting, Diprazine, Promedol, Droperidol are administered.
As an antidote, sodium citrate is used, disodium salt diluted with glucose.
With severe bradycardia and sinoatrial blockade, Atropine is administered subcutaneously.
With tachycardia, Verapamil is effective.
If hypoglycemia is detected, potassium preparations are prescribed.

After carrying out all resuscitation measures and stabilization of the patient's condition with positive dynamics on the ECG, he must be medically monitored for several days. A favorable prognosis is set if the patient's condition returns to normal within a day after poisoning.

Of greatest toxicological interest are those cumulating in the body cardiac glycosides and preparations from various types of foxglove- digitoxin, gitoxin, celanide, lantoside, digalen-neo and others, as well as glycosides from oleander adjacent to them in terms of pharmacological properties. Absorbed at different rates from the stomach and intestines: preparations of foxglove purpurea slowly, woolly (celanid) - quickly.

In the blood, they are adsorbed by plasma proteins, excreted slowly (cumulated) by the kidneys.

Digitalis poisoning and its preparations may occur either as a result of an overdose, or with prolonged use due to the ability of this group of cardiac glycosidoses to accumulate in the body, as well as due to increased sensitivity to them.

A lethal dose of foxglove leaves and squill bulbs 2-4 g digitoxin- 2-4 mg; for other digitalis-like drugs, it is 20-50 times the maintenance dose.

Pathogenesis and symptoms of poisoning. In the pathogenesis of poisoning with cardiac glycosides of the digitalis group, the deterioration of the work of the heart under the direct action of toxic doses of these drugs on it, as well as a direct effect on the central nervous system, in particular, a stimulating effect on the centers of the vagus nerve, is important. As a result of a sharp deterioration in atrioventricular conduction and increased excitability, significant cardiac arrhythmias can occur: extrasystole, bigeminia, partial or complete atrioventricular blockade with atrial fibrillation, tachysystole and paroxysmal tachycardia of ventricular origin. Impact on the central nervous system, in particular stimulation of the vomiting center, causes anorexia, nausea, and vomiting. Less common are neuropsychiatric disorders associated with hypoxic shifts and the effect of drugs on the activity of the cerebral cortex (motor excitation, delirium, convulsions, loss of consciousness). The inhibition of diuresis noted during the period of poisoning is associated with a central dysfunction of the vagus nerve and with a spasm of the renal vessels.

Symptoms of acute poisoning with cardiac glycosides: anorexia, nausea, persistent vomiting, hiccups, colicky pain in the epigastric region and abdomen, diarrhea with delayed diuresis. The pulse is sharply slow, irregular. Rhythm disorders - from individual extrasystoles, bigeminia to ventricular fibrillation, ventricular paroxysmal tachycardia (with complete atrioventricular blockade). Changes on the ECG are characteristic - prolongation of the PQ interval, displacement of the ST segment under the isoelectric line. Vision may be impaired: xanthopsia, diplopia, photophobia, etc. The pupils are dilated (rarely narrowed), exophthalmos, paresis of the eye muscles are observed.

Headache, weakness, drowsiness are noted, with severe poisoning - delirium, shortness of breath, cyanosis, coma, convulsions, lowering blood pressure, ventricular fibrillation, cardiac arrest in the diastolic stage.

Symptoms of irritation of the digestive system (colic, vomiting, diarrhea) are also clearly manifested in case of poisoning with oleander and its preparations.

First aid and treatment for poisoning with cardiac glycosides. Gastric lavage through a probe with a suspension of activated charcoal (20-30 g in 1 liter of water) or 0.2-0.5% tannin solution, followed by the introduction of saline laxative and cleansing enema. Emetics in case of poisoning with digitalis preparations and their analogues are contraindicated. The toxic effect of cardiac glycosides on the myocardium (arrhythmias, cardiogenic collapse) is stopped by potassium chloride. With normal kidney function, the latter is prescribed (in the absence of vomiting) by mouth at 0.5 g (dissolved in water) every 15 minutes or in the form of a 0.3% potassium chloride solution (in 5% glucose solution) slowly intravenously - until until an improvement is noticeable on the ECG or the content of potassium in the blood does not increase to 5 mmol / l.

With reduced kidney function, it is necessary to preliminarily determine the content of potassium in the blood serum before the introduction of potassium chloride. The maximum dose of potassium chloride on the first day after poisoning is 4 g; the next day - 2g. Intravenously, 20 ml of a 10% solution of tetashsh-kalshya with 300 ml of a 5% glucose solution are administered intravenously.

To reduce the toxic effect of cardiac glycosides, unithiol is also used (intramuscularly, 5 ml of a 5% solution 4 times a day) and disodium EDTA (2-4 g in a 5% glucose solution intravenously over 3-4 hours).

Apply anaprilin (10-30 mg 3 times a day), novocaine-amide - orally 0.5-1 g every 2 hours (total up to 4 g) or intramuscularly 5-10 ml of a 10% solution 3-4 times a day day, as well as quinidine sulfate - orally 0.2 g 3-4 times a day, novocaine - intravenously, 2-5 ml of a 0.25% solution 2-3 times a day. Severe bradycardia, nausea, vomiting are stopped by repeated administration of atropine sulfate (0.5-1 ml of a 0.1% solution under the skin).

To combat dehydration, parenteral fluid administration (isotonic sodium chloride solution, 5% glucose solution) is recommended. To eliminate hypoxia, inhalation of oxygen is used. The phenomena of excitation are stopped by barbiturates. In the event of cardiogenic collapse, vasoconstrictors (adrenaline hydrochloride, norepinephrine hydrotartrate) can cause ventricular fibrillation and are therefore contraindicated. In the treatment of acute poisoning with cardiac glycosides, strict bed rest is necessary.

Treatment acute poisoning, 1982

Cardiac (including cyanogenic) glycosides are drugs plant origin, which have a therapeutic effect and toxicity at the same time. In case of overdose, digitalis intoxication with cardiac glycosides may occur.

Digitalis intoxication occurs with excessive intake of "digitalis" - drugs that are part of the group of medicines for the heart. They are prescribed in the treatment of chronic arrhythmias, heart failure. Digitalis, Digitoxin, Digoxin are produced from the components of the foxglove plant.

Taking drugs can cause poisoning if there are health conditions:

elderly age;
work disruption thyroid gland;
diseases of excretory organs - liver and kidneys;
imbalance of minerals in the blood (lack of potassium, excess calcium) after taking diuretics;
hypoxia (lack of oxygen) caused by acute cardiac, respiratory failure;
post-infarction condition, heart surgery, any pathology.

A feature of treatment with cardiac glycosides is their long circulation in the blood. Digitalis preparations provoke an increase in contractions, an imbalance in the work of the heart occurs. Glycoside intoxication occurs, especially in the presence of problems with the kidneys and liver.

Symptoms of glycoside intoxication

The manifestation of symptoms depends on the degree of poisoning, they can be of different intensity. Signs of poisoning:

Cardiac symptoms: severe angina pectoris - squeezing, burning pain in the region of the heart, passing without medication in 10-15 minutes. There is an arrhythmia, a clear feeling of interruptions in the work of the heart.
Malfunctions of the digestive system: abdominal pain, lack of appetite, diarrhea, vomiting, nausea.
Headaches, migraine, anxiety, drowsiness, apathy.
The appearance of "flies" in the eyes, lowering the level of vision up to blindness.
A strong drop in blood pressure.
Severe signs of severe glycoside intoxication: epileptic convulsions, including in an unconscious state; severe damage to the central nervous system, falling into a coma, death.

Intoxication in severe form causes an immediate cessation of the heart.

During long-term treatment with digitalis preparations, patients periodically take a blood test that shows the concentration of cardiac glycosides in plasma.

With cardiac symptoms, poisoning with digitalis, digoxin is diagnosed after an electrocardiogram. It is especially important to order an ECG for early stage intoxication, glycoside poisoning can be chronic or acute.

The symptomatology of chronic intoxication differs from acute poisoning in less intensity and difficulty in detection. An electrocardiographic study should show what the cardiac mechanism of action of digoxin is in certain areas of the heart.

Rules for the provision of emergency care

The more acute the signs of poisoning are, the more severe the degree of intoxication of the patient, whose condition may worsen every minute. In such cases, it is required emergency help, the use of antidotes and antidotes. If there are signs of an overdose, it is necessary to urgently call ambulance, while waiting for which you can provide feasible measures at home:

urgent discontinuation of glycosides, in mild cases of poisoning - dose reduction;
inducing vomiting after drinking a lot of water;
elimination of toxins through the use saline solutions, receiving activated carbon, other adsorbents. Gastrointestinal lavage is performed in extreme cases and under medical supervision;
give the patient a warm sweet drink to drink, put him in a ventilated room;
in an unconscious state, turn the patient's head to one side so that he does not suffocate with vomit.

First aid to eliminate the consequences of poisoning with cardiac glycosides includes measures:

Multiple ECG for accurate diagnosis of the patient's condition, severity, recovery after an overdose.
The use of potassium, magnesium preparations, in severe conditions - intravenously.
After identifying the type of arrhythmia, antiarrhythmic drugs are prescribed.
The appointment of special antidotes, the dose of which is prescribed by the doctor.
Cardiac pacing in emergency cases.

In severe poisoning, hemodialysis is performed - a special procedure that cleanses the blood of toxins using an artificial kidney apparatus.

Providing rest to the patient and careful observation.

Antidote use

By International classification diseases (ICD) poisoning with cardiac glycosides is classified under the code T 46.0.

To eliminate the consequences of acute intoxication, the patient is prescribed an antidote of cardiac glycosides. The therapy consists in binding free digoxin in the blood plasma, stopping its effect on cardiac cells.

Antidote - fragments of special, specific antibodies that work against digitalis, which are formed in the body of sheep. Studying the pathogenesis of intoxication, scientists came to the conclusion that these antibodies are related to digoxin molecules. There are compounds at the molecular level with protein and a gradual withdrawal from the body.

Due to the risk of allergic reaction, with caution prescribe a digitalis antidote to people who cannot tolerate protein: chicken or sheep.

Assign an antidote in a dose proportional to the dose of absorbed digitalis glycoside. The instructions for the antidote contain a formula for calculating the dosage. The most famous digitalis antagonists are: Difenin, Digibind, Unitiol, Digitalis antidote BM.

Overview of drugs used for intoxication with cardiac glycosides

While the patient is in the clinic to eliminate the consequences of an overdose of cardiac glycosides, he is individually prescribed drugs that restore the body. Treatment depends on many factors: age, timing of drug use, the functioning of the liver, kidneys, the presence of chronic diseases.

Without fail, after taking an antidote (the appointment of an antidote depends on the severity of intoxication), toxins are removed with adsorbents: activated carbon, Enterosgel, Sorbex. Other drugs prescribed for poisoning may include:

to eliminate hypokalemia, replenish potassium in cardio organs, against dehydration - potassium chloride, insulin, glucose, Panangin, potassium orotate, Asparkam;
with bradycardia (slow pulse), vomiting, nausea - Atropine, which increases heart rate. It must be borne in mind that Atropine is contraindicated in tachycardia, as is the use of adrenaline (to avoid ventricular fibrillation);
magnesium sulfate preparation, provided that there are no disturbances in the functioning of the kidneys;
for the formation and excretion of calcium compounds that disrupt the functioning of blood vessels - Trilon B, citrate salts;
to stop arrhythmia - Propranolol, Lidocaine, Anaprilin, Novocainomide. Eliminates ventricular arrhythmias Phenytoin;
if necessary, prescribe anticonvulsants Aminosine, sodium oxybutyrate, Sibazon;
provide oxygen therapy to eliminate oxygen starvation organs;
prescribe vitamin therapy with vitamin E, group B, to maintain the cardiovascular system Riboxin, Aspicard.

Possible complications and prevention

Digitalis digitalis cardiac glycosides have been successfully used in the treatment of cardiac disorders. The main recommendations are an ECG, monitoring of potassium levels, observation by specialists. The benefits of treatment with digitalis greatly outweigh the risks of poisoning. When taken properly, the risk of intoxication is about 5%. Preparations are prescribed even for pregnant, lactating women under the supervision of the condition of the child and mother.

The main preventive measure for possible poisoning with cardiac glycosides is compliance with the dosage of digitalis preparations. The timing of the use of glycosides is important because of their ability to accumulate.

During the reception, careful monitoring of well-being is necessary. You need to eat foods containing potassium: dried apricots, dates, raisins, new potatoes.

If symptoms of poisoning are found, seek medical attention immediately.

Treatment of acute and chronic heart failure is often complicated by various side effects. One of these pathologies is considered. Any drug, depending on the dose, can be a salvation for the patient, and can cause severe complications. Cardiac glycosides are among the ten most unpredictable drugs. This is the main difficulty in the treatment of heart failure with this group of drugs.

Classification and mechanism of action of cardiac glycosides

According to the generally accepted classification of Spidenberg, this group of cardiac drugs is of two types. Specialists refer to the first type of foxglove derivatives, mainly purple and woolly. The second type of cardiac glycosides is obtained from strophanthus, May lily of the valley, jaundice and adonis.

It is the differences in the chemical structure that are the cause of the different quantitative and qualitative effects of glycosides on the patient's body. The action of strophanthin is considered the fastest and limited in time, and digitoxin has a slow effect on the heart, but with increasing force. The remaining drugs constitute the golden mean of this group of drugs.

When prescribing therapy for heart failure, cardiologists take into account three phases of the effect of cardiac glycosides on the patient's body:

The latency period is the time from the administration of a drug to a patient until the first symptoms appear. therapeutic effect.
Duration of drug action. This is the interval from the first symptoms of the action of glycosides to the end of their influence on the human body.
Period of optimal action of the drug.

Achievement speed clinical effect directly depends on the dose of cardiac glycosides and the method of their introduction into the patient's body. The higher the dose of the drug and the shorter the period of its absorption in the patient's blood, the faster the digitalization of the patient occurs. However, in this weak controllability of the process lies the high probability of an overdose of the drug.

The stronger the single daily dose of the drug differs from the toxic one, the lower the percentage of complications occurs during treatment. With a mild degree of heart failure, it is quite easy to calculate the optimal therapeutic dose, since the severity of the patient's condition makes it possible to manage with a minimum amount of drugs.

With the development of the disease, the condition of many patients worsens, the volume of cardiac glycosides for therapy increases, and the difference between therapeutic and toxic dose the drug is almost eliminated. It is this effect that in 70% of cases leads to poisoning with cardiac drugs.

The main causes of drug overdose

Poisoning with cardiac glycosides can occur against the background of an overdose of these drugs. Basically, this condition occurs in patients due to violation of the doctor's prescriptions, self-treatment of heart failure, or during a suicidal attempt.

Signs of an overdose of cardiac glycosides may appear in a patient among complete well-being and strict adherence to the dosage of the drug. This is possible, for example, when a patient develops a low content of plasma protein. The binding of cardiac glycosides in the blood is sharply reduced, and a large free fraction of the drug enhances and accelerates its effect on the patient.

In medical practice, there is also a certain percentage of poisoning by plants containing cardiac glycosides. With self-collection and use of lily of the valley, foxglove and adonis, for example, acute poisoning is more than likely.

An overdose of cardiac glycosides in 60-65% of cases causes acute intoxication, but there are also chronic poisonings when the clinical picture develops slowly.

According to the majority medical institutions, poisoning with cardiac glycosides is diagnosed in 7-40% of patients taking these drugs. Such a large variation is due to the severity of the disease.

Symptoms of poisoning with cardiac glycosides

Symptoms of an overdose of cardiac glycosides are mainly observed from the side of the heart. First of all, there is a failure of the contractile function of the myocardium, various rhythm disturbances are diagnosed. Most often, which becomes the main symptom of poisoning, non-paroxysmal tachycardia develops, the atrioventricular node becomes the center of the heart rhythm change. In more rare cases of intoxication, experts note the occurrence of bradycardia, ventricular extrasystole and atrial fibrillation. If any rhythm disturbances occur, the intake of cardiac glycosides must be urgently stopped.

It does not stand aside in case of poisoning by this group of drugs and the gastrointestinal tract. Patients report nausea, vomiting, sharp pains in the abdomen and upset stool. Quite often, such symptoms do not allow a quick diagnosis of an overdose of glycosides and leads to a prolongation of treatment.

Signs of intoxication in case of drug poisoning can also be from the side of the central nervous system, which manifests itself in the form of:

headache,
dizziness,
decrease in visual acuity,
the appearance of colored spots before the eyes.

Patients who have undergone similar poisoning noted the presence of hallucinations and other mental disorders. The severity of mental disorders directly depends on the severity of the patient's condition with an overdose of cardiac glycosides.

We must not forget about the violation of the conduction of the heart. Such a pathology in acute glycoside poisoning is quite rare, however, even those 6–10% of the development of various blockades pose a serious threat to health and life in case of an overdose of cardiac drugs.

Diagnosis in the hospital

For differential diagnosis This pathology specialists use the full range of available opportunities. Clinical picture and the corresponding anamnesis in most cases make it possible to make a correct diagnosis in a timely manner. To confirm thoughts of poisoning with cardiac glycosides, the ECG becomes the first assistant to clinicians. There are enough signs of the development of this formidable pathology:

arcuate change in the ST segment and a decrease in amplitude with inversion of the T wave;
a sharp change in heart rate when taking cardiac glycosides, characterized by the presence of extrasystoles, sinus bradycardia and, in rare cases, atrial flutter;
development of atrial or ventricular tachycardia with the presence of complete AV blockade;
the alternation of positive and negative QRS complexes suggests the possible occurrence of bidirectional ventricular tachycardia.

For an overdose of cardiac glycosides, the ECG is characterized by the presence of one or more of the above signs.

Laboratory services can also contribute to obtaining a complete and final diagnosis. Elevated levels of cardiac glycosides in the blood and hypokalemia will help confirm the assumption of poisoning with these drugs.

Rules for the treatment of acute poisoning with cardiac glycosides

Treatment for an overdose of cardiac glycosides is carried out only in a hospital, quite often the victims have to spend several days in the intensive care unit. When the first signs of poisoning appear, it is urgent to seek help from doctors and not self-medicate.

Before the arrival of the ambulance team, the patient must be comfortably laid down and provided with fresh air. Due to poisoning with cardiac glycosides, most often there are disturbances in the rhythm of the heart, any exercise stress may harm the victim. That is why it is not recommended to wash the stomach or try to induce vomiting in the patient.

Medical treatment in the hospital depends on the conditions of the patient and the presence of various clinical symptoms. If bradycardia is detected, the patient is prescribed injections of atropine, and with the development of tachycardia, potassium preparations and b-blockers are used.

In such conditions, a decrease in the level of potassium in the blood is often observed, so treatment begins with an intravenous drip of a polarizing mixture, where potassium chloride is combined with 5% glucose. Magnesium preparations will not become superfluous. The use of these medicinal substances will reduce intoxication and cause increased kidney function.

The development of ventricular arrhythmia in a patient with an overdose of cardiac glycosides urgently requires the inclusion of antiarrhythmic drugs, in particular lidocaine, in the treatment regimen. This medicine can be used as an intravenous injection or drip at a rate of 30 mg/kg per minute.

To speed up the treatment process from the first minutes of the development of the glycoside poisoning clinic, the victim can take activated charcoal. This will enhance the excretion of intoxication products from the body and will contribute to the correction of acidosis.

If during the first day intensive care positive dynamics is achieved, then the prognosis of acute poisoning is considered favorable, although mortality in case of an overdose of cardiac glycosides ranges from 8% to 15% of victims. Most often, mortality is associated with a delay in the provision of qualified assistance.

After discharge from the hospital for 6 months, a constant monitoring of the patient's condition is carried out. To do this, use an ECG every two weeks, regularly determine the level of concentration of potassium and glycosides in the patient's blood. In addition, specialists are developing a specific diet for this category of patients.

An overdose of cardiac glycosides is serious complication in the treatment of heart failure. From timely diagnosis and early start drug therapy often depends on the health and life of the patient. Do not rely on yourself, it is better to trust the specialists

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Overdose of cardiac glycosides

Cardiac glycosides, along with many other drugs, are used in heart failure and in atrial tachyarrhythmias to reduce the frequency of ventricular contractions. Of the cardiac glycosides, digoxin is most often prescribed. Due to the narrow therapeutic window and their wide use, acute and chronic overdose of cardiac glycosides continues to be a frequent and serious complication.

In the elderly, the risk of overdose with cardiac glycosides is especially high, which may be due to both age-related malabsorption and elimination disorders and the interaction of cardiac glycosides with other constantly taken drugs. An overdose of cardiac glycosides can also be caused by eating certain plants and animals. Cardiac glycosides are found in common oleander (Nerium oleander), yellow oleander (Thevetia peruviana), foxglove (Digitalis spp.), May lily of the valley (Convallaria majalis), hemp kendyr (Apocynum cannabinum), sea onion (Urginea maritima) and dried secretion of the toad aga (Bufo marinus).

Pharmacokinetics

The effects of cardiac glycosides depend on the average serum concentration of the drug, which, in turn, is determined by the rates of absorption, distribution and excretion. Digoxin is characterized by a biphasic distribution, so a high serum concentration of the drug, measured within 6 hours after administration (in the distribution phase, when the concentration of the drug in the tissues increases), can be misleading. In the second phase (elimination phase), T1 / 2 is approximately 36 hours.

The intake of loop diuretics and ion-exchange resins that bind potassium, as well as insufficient intake of potassium from food and diarrhea, can cause hypokalemia, which enhances the effects of cardiac glycosides and causes heart rhythm disturbances at lower serum concentrations of these drugs. Taking antibiotics, especially macrolides, can suppress the metabolism of digoxin.

Symptoms of an overdose of cardiac glycosides

Glycoside intoxication is equally manifested in children and adults. In acute and chronic glycoside intoxication, the nature of the symptoms is different.

Extracardiac manifestations

Acute glycoside intoxication

The asymptomatic period after taking cardiac glycosides lasts from several minutes to several hours, then the first symptoms appear, usually nausea, vomiting and abdominal pain. The central manifestations include drowsiness, stupor and weakness, not associated with hemodynamic disturbances.

Chronic glycoside intoxication

Chronic overdose of cardiac glycosides is often difficult to diagnose due to the gradual development and variety of manifestations. Symptoms are the same as in acute glycoside intoxication, but often they are less pronounced. Gastrointestinal disturbances, confusion, disorientation, drowsiness, visual disturbances (eg, rainbow rings around luminous objects), hallucinations, and occasionally epileptic seizures may occur.

Electrolyte disorders

In acute glycoside intoxication, hyperkalemia has an important prognostic value: potassium levels are more correlated with the likelihood of death than early changes in the ECG and serum concentration of glycosides. But hyperkalemia is only an indicator of the severity of intoxication, but not the immediate cause of complications and death, so a simple correction of potassium levels does not increase survival.

Cardiac manifestations

With an overdose of glycosides, almost any arrhythmias are possible, with the exception of supraventricular tachyarrhythmias with high AV conduction. The first and most common cardiac arrhythmias are usually ventricular extrasystoles. Although there are no arrhythmias pathognomonic for glycoside intoxication, this condition is suspected in bidirectional ventricular tachycardia, atrial tachycardia with high-degree AV block.

Acute overdose of cardiac glycosides

In the early period of acute overdose of cardiac glycosides, increased parasympathetic influences on the sinus and AV nodes cause bradyarrhythmias, which are treatable with atropine.

Chronic overdose of cardiac glycosides

Bradyarrhythmias that develop in the late period of acute glycoside intoxication and chronic glycoside intoxication are due to the direct action of cardiac glycosides on the heart. These arrhythmias, as a rule, practically do not respond to the introduction of atropine. Ventricular tachyarrhythmias occur in chronic glycoside intoxication or in the late period of acute glycoside intoxication more often than in the early period of acute glycoside intoxication.

Determination of the serum concentration of digoxin has great importance for the management of patients with an overdose of cardiac glycosides. Usually, clinical symptoms appear when the serum concentration of digoxin (measured no earlier than 6 hours after its administration) exceeds 2 ng / ml (therapeutic range - 0.5-2 ng / ml). Only an elevated concentration of digoxin is not the basis for the diagnosis of glycoside intoxication: the patient's condition, the time interval between taking the last dose of the drug and taking a blood sample, electrolyte disturbances (especially hyper- or hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia and alkalosis), the presence of hypothyroidism and hypoxemia, as well as the use of catecholamines, calcium antagonists, quinidine, amiodarone and diuretics.

Most tests for digoxin give a positive reaction with other cardiac glycosides. The detection of such glycosides is important, but the clinical significance of measuring their serum concentration has not yet been established. Some cardiac glycosides are not detected by the reaction to digoxin, so its negative results do not exclude glycoside intoxication.

There are ways to measure both total and free digoxin. It is usually sufficient to determine the serum concentration of total digoxin, which correlates well with the concentration of digoxin in the heart. However, after the use of antidigoxin, which almost completely remains in the vascular bed (volume of distribution 0.4 l / kg), the serum concentration of total digoxin rises sharply, since cardiac glycosides leave the tissues into the bloodstream, bind to antidigoxin and remain in the blood. In this case, the determination of only free digoxin is of clinical importance.

Endogenous digoxin-like immunoreactive factor

Sometimes positive reaction digoxin occurs in people who have not received cardiac glycosides. This is due to the presence of the so-called endogenous digoxin-like immunoreactive factor, structurally and functionally similar to cardiac glycosides. This factor appears in cases where it is necessary to increase the strength of heart contractions or when kidney function is reduced - in particular, in newborns, pregnant women, in patients with renal insufficiency, liver disease or hypothermia.

Treatment of overdose with cardiac glycosides

In acute glycoside intoxication, they begin with general supportive measures, the abolition of cardiac glycosides, preventing their further intake and absorption in the gastrointestinal tract. Further, ECG monitoring is established, serum concentrations of electrolytes and digoxin are determined, antidigoxin is prescribed and arrhythmias, electrolyte disturbances and other complications are eliminated.

Prevention of absorption in the gastrointestinal tract

Artificial vomiting and gastric lavage are usually ineffective. Most cardiac glycosides are involved in the intestinal circulation, so delayed or repeated administration of activated charcoal may help reduce their serum concentration, especially in the absence of an antidote. With prolonged use of cardiac glycosides, measures to prevent their absorption in the gastrointestinal tract are ineffective.

Specific treatment

Antidigoxin

The use of this drug is part of the standard treatment plan for cardiac glycoside overdose. Despite the high cost of antidigoxin, the benefit from reduced risk of complications, lengthy intensive care unit stays, and repeated determinations of serum potassium and digoxin concentrations is much greater.

Medical treatment of arrhythmias

With hemodynamically significant supraventricular bradyarrhythmias or high-degree AV blockade, atropine is administered intravenously: adults 0.5 mg, children 0.02 mg/kg, but not less than 0.1 mg. With ventricular arrhythmias and the inability to immediately administer antidigoxin, phenytoin and lidocaine are prescribed at usual doses.

Pacing and electrical cardioversion

External pacing in some cases may be useful in case of sustained bradyarrhythmia. Endocardial pacing is contraindicated as it can cause fatal ventricular arrhythmias. Electrical cardioversion is used only for severe, life-threatening arrhythmias. In the presence of antidigoxin, the need for electrical cardioversion is rare.

Correction of electrolyte disorders

Hypokalemia, most commonly associated with diuretics, may enhance the cardiotoxic effect of cardiac glycosides. Correction of hypokalemia is sometimes enough to eliminate the tachyarrhythmia. By itself, glycoside intoxication, on the contrary, causes hyperkalemia: In acute overdose of glycosides, antidigoxin is indicated if the potassium level exceeds 5.0 mEq / l. If hyperkalemia is accompanied by characteristic ECG changes, and it is not possible to immediately administer antidigoxin, one should try to reduce the level of potassium in / in the introduction of insulin, glucose, sodium bicarbonate and oral administration of a potassium-binding ion-exchange resin - sodium polystyrene sulfonate. Calcium chloride has good effect in most patients with hyperkalemia, but in the case of glycoside intoxication, the use of calcium salts can be extremely dangerous, since in such patients the intracellular calcium concentration is already increased.

With heart failure and an overdose of glycosides, hypomagnesemia is sometimes observed due to long-term use of diuretics. It can lead to persistent hypokalemia not corrected by potassium administration, so magnesium sulfate is administered to such patients (in addition, magnesium sulfate can eliminate extrasystoles, although this is only a temporary measure used before antidigoxin treatment is started). Magnesium sulfate is often prescribed at a dose of 2 g IV over 20 minutes for adults and at a dose of 25-50 mg/kg, but not more than 2 g, for children. After normalization of the condition in severe hypomagnesemia, adults may need to administer magnesium sulfate at 1-2 g / h, and children at a rate of 25-50 mg / kg / h, but not more than 2 g / h.

Extracorporeal detoxification

Forced diuresis, hemosorption and hemodialysis do not accelerate the elimination of digoxin due to the large volume of distribution.

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Overdose of cardiac glycosides

Cardiac glycosides are a group medicines, which are indicated for the treatment of certain cardiac diseases. Uncontrolled or incorrect intake of them can lead to severe poisoning. In this article, we looked at the reasons why digitalis intoxication can develop, its signs and symptoms, ways to provide first aid. first aid and elements of treatment.

What are cardiac glycosides, for which diseases they are prescribed

Cardiac glycosides are drugs that are used to treat heart failure and various arrhythmias. The most commonly used drug in medicine is Digoxin, which is made from the plant Digitalis lanata. The following representatives of this group also apply:

"Strophanthin";
"Korglikon";
"Digitoxin";
"Celanide".

Please note that you can take cardiac glycosides only as directed by a doctor. If used incorrectly, they severe violations in the work of the whole organism, especially suffers the cardiovascular system.

Cardiac glycosides are prescribed for the following pathologies:

chronic heart failure with symptoms of circulatory stagnation;
atrial fibrillation;
atrial fibrillation;
paroxysmal tachycardia.

Causes of the development of poisoning with cardiac glycosides

Glycoside intoxication can develop for many reasons. Taking these drugs requires the patient to follow all the recommendations given to him by the attending doctor. The following are the main reasons why cardiac glycoside poisoning can develop:

Overdose of cardiac glycosides. It develops as a result of taking large doses of the drug.
Violation of the kidneys in a patient, as a result of which the drugs cannot be fully excreted from the body and accumulate in it, causing intoxication.
A sharp decrease in the level of potassium in the blood, which most often develops due to uncontrolled intake diuretics. Patients with congestion in heart failure suffer from severe edema and drink diuretics to quickly remove fluid.
Acute or chronic liver failure. Enzymatic reactions of metabolization of cardiac glycosides occur in the liver.
The patient has severe heart disease coronary disease heart, cicatricial changes in the myocardium, myocarditis).
Hyperthyroidism is an overworking of the thyroid gland, in which the level of hormones in the blood rises sharply.
Decrease in the amount of protein in the blood.

Clinical signs of digitalis intoxication

Symptoms of an overdose of cardiac glycosides may develop slowly or quickly. The time depends on the severity of the poisoning. First of all, there are signs of disruption of the heart and digestive system.

Please note that acute intoxication with cardiac glycosides can cause immediate cardiac arrest.

The following are signs of an overdose of cardiac glycosides:

Appearance pain in the region of the heart, the development of an attack of angina pectoris. The pain is burning and squeezing in nature. With absence drug treatment usually resolves on its own within 10-15 minutes.
Feeling of malfunctions in the work of the heart, indicating the development of arrhythmia.
Anorexia is a lack of appetite.
Nausea, vomiting, diarrhea and abdominal pain.
severe pain in the head, resembling a migraine attack.
General weakness, drowsiness and lethargy. The patient may develop an anxiety attack.
Sensation of floating flies before the eyes, decreased visual acuity up to complete blindness.
A sharp drop in blood pressure.
Development of generalized convulsions throughout the body, as in an epileptic seizure. Convulsions can develop against the background of an absent consciousness.
Loss of consciousness and falling into a deep coma are signs of a total defeat of the central nervous system due to acute heart failure and an increase in hypoxia.

If a person taking cardiac glycosides begins to show the first signs of intoxication, you should immediately stop taking these medications and call an ambulance.

Please note that it is very dangerous to self-medicate digitalis intoxication. A poisoned patient can die at any moment from respiratory arrest. Only physicians can objectively assess the severity of the condition of a poisoned person and prescribe correct treatment.

Before the arrival of doctors, you should begin to conduct first aid. Thanks to her, you can slightly improve the patient's condition and give him a chance to wait for the doctors. Below is a description of the actions by which you can help the patient while waiting for the EMS team:

Give the patient a drink a large number of water and explain to him the need to vomit it. Gagging can be provoked by pressing a finger on the root of the tongue. This procedure will help to remove the remnants of the drug from the stomach.
Find drugs from the sorbent group in the home medicine cabinet and give them to the patient to drink. It can be activated carbon, atoxyl, smecta, sorbex, enterosgel, etc. Sorbents partially neutralize drugs that remain in digestive system, and help to avoid increased intoxication.
Drink the poisoned person with warm sweet tea or plain water. Lay it on the bed and open the windows for ventilation.

If a person has lost consciousness before the arrival of doctors, you should turn his head to one side so that he does not choke on vomit. Control his pulse and breathing, when they stop, start doing indirect massage hearts.

Medical care and treatment

Upon arrival, the SPM doctors will collect an anamnesis and conduct a quick assessment of the patient's condition. First they check arterial pressure, pulse and respiration rate, saturation level, and then an electrocardiogram will be taken.

After the introduction of medications necessary to maintain vital signs, the patient is urgently transported to the intensive care unit.

In the treatment of digitalis intoxication, it is necessary to use an antidote - specific antibodies against digoxin. This antidote helps to remove and neutralize drug residues.

Therapy for cardiac glycoside poisoning consists of the following components:

Administer oxygen to the patient through a mask.
Intravenous administration drugs to normalize the electrolyte balance (carried out under the control of blood tests).
The introduction of atropine in order to accelerate the pulse.
Anticonvulsants.
Droppers with solutions to reduce dehydration.
In severe poisoning, hemodialysis is performed - blood purification using an artificial kidney.

The prognosis for the life of the patient depends on the dose of the drug with which he was poisoned, the timely provision of first aid and the state of the body as a whole, the presence of concomitant pathologies.

Digitalis intoxication develops as a result of improper treatment with cardiac glycosides. The dosage of these drugs is calculated by the doctor individually for each patient and must be strictly adhered to. When the first signs of poisoning with cardiac glycosides appear, you need to call an ambulance. Treatment in a hospital is prescribed based on the severity of the patient's condition. In case of severe poisoning, hemodialysis is indicated.

poisoning.ru

Overdose of cardiac glycosides: clinical manifestations, treatment of poisoning

Questions about CCC

Cardiac glycosides: sources of obtaining; chemical structure; mechanism of cardiotonic action; pharmacological effects.

Heart ch. - complex nitrogen-free plant compounds that have a selective effect on the heart, which is realized mainly through a pronounced cardiotonic effect.

East Received - different kinds foxglove (large-flowered, purple, rusty, woolly), spring adonis, oleander, May lily of the valley, obvonik.

Chemical structure - in the structure of cardiac glycosides, two main parts are distinguished:

Sugar part (glycone), which is a chain of sugars, which can be from one to four,

The non-sugar part (aglycone), which includes the steroid fragment and the lactone ring. In the molecules of g., sugar residues are associated with aglycone, which is the pharmacologically active part of the glycoside.

MD: Small doses increase the content of catecholamines in the myocardium, stimulate the Na + -K + pump and have a positive inotropic effect. Higher doses inhibit the Na + -K + pump, increase the intracellular content of sodium ions and activate the transsarcolemmal Na + -Ca2 + exchange system, stimulating the entry of calcium ions into the cells, which further enhances the positive inotropic effect.

main mechanisms:

1) coefficient increase useful action tired muscle without increasing its supply of oxygen with an increase in energy consumption for contraction and with a decrease in energy consumption for heat generation; 2) anti-dystrophic effect during hypoxia, heart overload, 3) inhibition of automatism due to an increase in the tone of the parasympathetic nervous system and a direct effect on the sinus node;

4) conduction slowdown; 5) increased excitability, especially secondary and tertiary centers located in the ventricles.

Pharm. Eph. - Cardiac glycosides have a positive inotropic, negative dromotropic, chronotropic effect, in small doses - negative, and in large doses - positive bathmotropic. The drugs increase and shorten the duration of systole, increase the minute and stroke volume, lengthen the diastole, improve blood circulation, bring arterial and venous pressure closer to normal, reduce the volume of circulating blood, edema, increase diuresis, and have a calming effect on the central nervous system.

Comparative characteristics cardiac glycosides: digitoxin, digoxin, strophanthin, lanatoside.

Absorption: digitoxin has the highest - up to 100%, Digoxin - 60-80%, strafantin - hydrophobic, not absorbed, Lanatoside - 20-60%.

Beginning of action: digitoxin - h/h 20-30 min, max. b/w 2 h, dig. 1-3 hours, stanzas. 5-10 min, lanat. 5-30 min.

Max. The action of digitox. – h-h 6-12 hours, digok. 4-6 hours, stanzas. 1.5-2 hours, lanatoside in a vein 2-3 hours, orally - 4-6 hours.

Continue. Action: digit. 14-21 days, digox - 5 days, stroph. 2-3 days

T1 / 2: digit - 5 days, digok - 36 hours, stanza. 23h, lan. 28-36 hours

Doses: digit. saturation 1-1.5 mg per second, support. 0.1 mg, digox. Sat. 1 - 1.5 mg per second, support. 0.125 - 0.5 mg, strovantine sat. 0.5 - 0.75 mg per second, lan sat - 0.5 mg, support - 0.2-0.4 in a vein, inside - 0.5 - 0.25 mg.

Overdose of cardiac glycosides: clinical manifestations, poisoning treatment.

CCC: bradycardia, extrasystole (especially bigeminia), tachycardia (especially paroxysmal tachycardia from the atrioventricular node) that occurs after a period of normalization of heart rate or bradycardia, atrial fibrillation. Gastrointestinal: abdominal pain, nausea, vomiting CNS: headache, dizziness, nightmares, depression, hallucinations ECG signs: Elongation interval P-Q>0.20 s, Shortening Q-T interval, sinus bradycardia, extrasystoles, bundle branch block

Lab. Diagn. Increase in the content of SG in the blood, Hypokalemia.

Mode - stationary with limited physical activity, the abolition of digitalis preparations, maintaining the optimal concentration of electrolytes in blood plasma, potassium - 5.5.

With bradycardia - atropine.

With intoxication against the background of hypokalemia - potassium preparations.

For ventricular arrhythmias, lidocaine

Magnesium preparations are indicated for each patient with suspected dig. Intox.

acidosis correction.

Observation

Frequent holding ECG, determination of concentrations of potassium and SG in blood plasma, monitoring of kidney function.

4. Cardiotonic drugs of non-glycoside structure: classification, characteristics.

Cardiotonic drugs Lek. means, increase myocardial contractility, regardless of changes in pre- and afterload on the heart. The general property of K. s. is a positive inotropic effect on the heart, i. the ability to increase the strength of heart contractions (increase in stroke volume and cardiac output). The volume at the end of diastole, ventricular filling pressure, pulmonary and systemic venous pressure under the influence of K. can decrease.

According to the mechanism of action, the first group of non-glycoside cardiotonic drugs can be represented as follows. Means that increase the content of cAMP and Ca2+ ions in cardiomyocytes: 1) Means that stimulate β 1-adrenergic receptors Dopamine Dobutamine (stimulation of β1-adren of the heart - adenylate cyclase is activated => increased content of cAMP in cardiomyocytes => the concentration of Ca ions increases => the strength of heart contractions increases ). 2) Phosphodiesterase inhibitors Amrinone Milrinone. DOPAMINE (dopmin) acts on: 1) dopamine receptors 2) indirectly stimulates α- and β-adrenergic doses 3) in medium doses has a positive inotropic effect (due to stimulation of β1-adrenergic receptors of the heart) - dilation of renal and mesenteric vessels. with cardiogenic shock. May cause tachycardia, arrhythmia, excessive increase in peripheral vascular resistance and heart function.

A dopamine derivative, DOBUTAMIN, which is a β1-adrenergic agonist, acts more selectively. It is characterized by a pronounced cardiotonic activity. Dobutamine is used for short-term stimulation of the heart during its decompensation. Dopamine and dobutamine are administered intravenously by infusion. AMRINONE - (derivative of bispiperidine) increases the contractile activity of the myocardium and causes vasodilation. Apply only for a short time (cc) in acute cardiac decompensation. May cause mild hypotension, cardiac arrhythmias. Inside do not prescribe-causes many side effects and with prolonged use shortens life expectancy. Similar in structure and action to Milrinon. Non-glycoside cardiotonic drugs also include drugs that increase the sensitivity of myofibrils to calcium ions - LEVOSIMENDAN (simdax) - Mech. without increasing myocardial oxygen consumption. ON causes expansion of coronary and other vessels (veins and arteries) - activation of KATP channels of vascular smooth muscle) In high concentration, it also inhibits phosphodiesterase III. The vasodilating effect of levosimendan is manifested by an improvement in coronary circulation, a decrease in total peripheral vascular resistance, a decrease in pressure in capacitive vessels and pulmonary arteries, a decrease in pre- and afterload on the heart. All this favors the normalization of the work of the heart in case of its insufficiency. used to treat acute cardiac decompensation of PD, headache, arterial hypotension, dizziness, nausea, hypokalemia are possible.

5. Antiarrhythmic drugs: classification: I. Drugs that predominantly block ion channels of cardiomyocytes (the conduction system of the heart and contractile myocardium) 1. Drugs that block sodium channels (membrane stabilizing agents; group (I) Subgroup IA (quinidine and quinidine-like drugs): Quinidine sulfate Disopyramide Novocainamide Aymaline Subgroup IB: Lidocaine Difenin Hydration IC (Flecainide Propafenone Ethmosine Etacizine) 2. L-type calcium channel blockers (Group IV) Verapamil Diltiazem 3. Potassium channel blockers (drugs that increase repolar duration and PD; group III) Amiodarone Ornid Sotalol

4. Agents that selectively block Na + -K + incoming current (If) of the sinus node (group V; bradycardic agents) Ivabradine Falipamil Alinidin

II. Drugs that mainly affect the receptors of the efferent innervation of the heart Drugs that weaken adrenergic influences (group II) β-Adrenergic blockers: Anaprilin, etc. Drugs that enhance adrenergic effects β-Adrenergic agonists: Isadrin Sympathomimetics: Ephedrine

III. Various drugs with antiarrhythmic activity Potassium and magnesium preparations Cardiac glycosides Adenosine Chemical agents with antiarrhythmic activity belong to different classes of compounds. Quinidine, novocainamide, ethmozine, ethacizine and aimaline are used only as antiarrhythmic drugs. Group I - sodium channel blockers (subgroup 1A - quinidine and quinidine-like agents; subgroup IB - lidocaine and diphenine; subgroup IC - flecainide, encainide, etc.); Group II - drugs that depress adrenergic effects on the heart (β-blockers); Group III - drugs that increase the duration of the repolarization process and lengthen the action potential (amiodarone, ornid, sotalol); IV group - drugs that block calcium channels (verapamil); V group - selective bradycardic drugs (alinidin, ivabradine); group VI - cardiac glycosides (digoxin, digitoxin); group VII - agents that enhance the effect (tonus) vagus nerves with supraventricular tachycardia (mesaton, edrophonium).

When to perform cardiopulmonary resuscitation