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Cardiovasc Toxicol 2022 01 16;22(1):78-87. Epub 2021 Oct 16.

Escola de Veterinária da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

In the present study, we investigated the cardioactive glycosides oleandrin and ouabain, and compared them to digoxin in a model of cardiotoxicity induced by doxorubicin. Adult rats were distributed into four experimental groups. Each group was challenged with a single intraperitoneal application of doxorubicin at a dose of 12 mg/kg. Read More

Cureus 2021 Aug 31;13(8):e17599. Epub 2021 Aug 31.

Internal Medicine, University of Alabama, Tuscaloosa, USA.

Since the publication of the Digitalis Investigation Group trial in 1997, digoxin use has declined significantly. Medications such as angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) and beta-blockers that have been demonstrated to have a decrease in morbidity and mortality are prescribed in favor of digoxin. Despite the reduction in digoxin use and improved therapeutic monitoring, digoxin toxicity remains a significant cause of morbidity and mortality. Read More

Foods 2021 Aug 3;10(8). Epub 2021 Aug 3.

Center for Food Safety and Applied Nutrition, Office of Regulatory Science, U.S. Food and Drug Administration, College Park, MD 20740, USA.

The botanical genus is equal parts colorful, toxic, and medicinal, and its bioactive compounds have a long history of therapeutic use. However, with an extremely narrow therapeutic range, even trace amounts of can cause adverse effects. Using chemical methods, the United States Food and Drug Administration traced a 1997 case of toxicity to a shipment of (a common ingredient in dietary supplements marketed to improve digestion) contaminated with . Read More

Circulation 2021 06 7;143(23):2312-2315. Epub 2021 Jun 7.

Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Now with Department of Cardiology, Government Medical College and Hospital, Chandigarh, India.

Ophthalmol Retina 2021 11 6;5(11):1173-1175. Epub 2021 May 6.

Retina Service, Weill Cornell Medicine, New York, New York. Electronic address:

Parasite 2021 14;28:38. Epub 2021 Apr 14.

Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100 Minas Gerais, Brazil - Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901 Minas Gerais, Brazil.

Current treatments of visceral leishmaniasis face limitations due to drug side effects and/or high cost, along with the emergence of parasite resistance. Novel and low-cost antileishmanial agents are therefore required. We report herein the antileishmanial activity of β-acetyl-digitoxin (b-AD), a cardenolide isolated from Digitalis lanata leaves, assayed in vitro and in vivo against Leishmania infantum. Read More

Mil Med 2021 Feb 19. Epub 2021 Feb 19.

Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA.

Bidirectional ventricular tachycardia (VT) is a rare ventricular dysrhythmia with a limited differential diagnosis that includes digitalis toxicity, catecholaminergic polymorphic VT, aconite poisoning, and genetic channelopathy syndromes, specifically, Andersen-Tawil syndrome (ATS). We present a case of a young female with palpitations found to have bidirectional VT on cardiac event monitor and strong family history of cardiac dysrhythmias. Her physical examination findings included minor dysmorphic features of mandibular hypoplasia, hypertelorism, and clinodactyly. Read More

Eur Heart J Case Rep 2021 Feb 4;5(2):ytab022. Epub 2021 Feb 4.

Cardiology Department, University Hospital Waterford, Waterford, Ireland.

Background: Chorea secondary to digoxin toxicity is rare, with only three published cases describing the phenomenon. We report the case of a 78-year-old female presenting with intermittent vomiting and diarrhoea for 4 weeks. She had a history of chronic kidney disease and digoxin use for atrial fibrillation. Read More

Cardiooncology 2020 Nov 5;6(1):24. Epub 2020 Nov 5.

Cardio-Oncology Department, Roffo Institute, 5481 Av San Martin. CABA,, Buenos Aires, Argentina.

Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but there is no well-established evidence on how sacubitril/valsartan may help cancer patients with cardiotoxicity.

Objectives: The aim of this trial was to study the effectiveness of sacubitril-valsartan in patients with CTRCD treated in cardio-oncology units. Read More

Hellenic J Cardiol 2021 Nov-Dec;62(6):480-484. Epub 2020 Nov 20.

General Hospital of Nikea-Piraeus, Agios Panteleimonas, Mantouvalou 3, Nikea Attikis, 18453, Greece. Electronic address:

Parasitol Res 2021 Jan 16;120(1):321-335. Epub 2020 Nov 16.

Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Treatment for visceral leishmaniasis (VL) is hampered mainly by drug toxicity, their high cost, and parasite resistance. Drug development is a long and pricey process, and therefore, drug repositioning may be an alternative worth pursuing. Cardenolides are used to treat cardiac diseases, especially those obtained from Digitalis species. Read More

Case Rep Ophthalmol Med 2020 16;2020:2983947. Epub 2020 Jan 16.

Faculty of Health Studies, University in Mostar, Bosnia and Herzegovina.

The common toad produces venom (bufotoxin) that is produced in the parotid gland of the toad as well as in the skin. This toxic compound is a potent inhibitor of Na/K-ATPase activity. Physiological effects of bufotoxin are similar to those of digitalis and cause increased heart rate and muscle contractions. Read More

Case Rep Cardiol 2019 29;2019:9707428. Epub 2019 Nov 29.

Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, Milan, Italy.

Foxglove ( L.) leaves are frequently confused with borage ( L.), which is traditionally used as a food ingredient. Read More

JACC Case Rep 2019 Jun 19;1(1):21-26. Epub 2019 Jun 19.

Aurora Center for Advanced Atrial Fibrillation Therapies, Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin.

Bidirectional ventricular tachycardia (BDVT), a rare ventricular arrhythmia, is commonly caused by digitalis toxicity or channelopathies and is rarely caused by aconite toxicity, myocarditis, infarction, or sarcoidosis. This paper describes a patient with BDVT, recurrent syncope, myocardial disarray, and interstitial fibrosis on histology but normal results on echocardiography with variants in the , , and genes. (). Read More

Cardiovasc Toxicol 2019 06;19(3):237-243

Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany.

A post hoc analysis of the PALLAS trial suggested life-threatening interactions of digitalis and dronedarone. Thus, there is concern about an interplay between digitalis and other drugs that influence cardiac electrophysiology. We therefore investigated the interaction between digitalis and flecainide or ranolazine. Read More

Circ J 2018 12 23;83(1):41-51. Epub 2018 Oct 23.

Centro de Investigaciones Cardiovasculares, CONICET La Plata, Facultad de Ciencias Médicas, Universidad Nacional de La Plata.

Background: It has been shown that carvedilol and its non β-blocking analog, VK-II-86, inhibit spontaneous Ca release from the sarcoplasmic reticulum (SR). The aim of this study is to determine whether carvedilol and VK-II-86 suppress ouabain-induced arrhythmogenic Ca waves and apoptosis in cardiac myocytes. Methods and Results: Rat cardiac myocytes were exposed to toxic doses of ouabain (50 µmol/L). Read More

Ochsner J 2018 ;18(3):288-290

Department of Cardiology, University of Miami/JFK Medical Center, Atlantis, FL.

Background: Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies.

Case Report: A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. Read More

Drug Chem Toxicol 2020 Nov 21;43(6):553-559. Epub 2018 Sep 21.

Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Digoxin is a cardiac glycoside derived from the common foxglove and has been available for several centuries as a medicinal agent. Despite extensive patient experience over many years, there remains some controversy regarding the possibility that digoxin might have a deleterious effect on survival. This study was constructed to assess trends in digoxin toxicity research using well-established qualitative and quantitative bibliometric indicators. Read More

Biomed Pharmacother 2018 Sep 6;105:533-539. Epub 2018 Jun 6.

Department of Pharmacology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.

Background: Toxic effects of digoxin may occur with normal therapeutic serum level. However, the underlying mechanisms are not fully understood. Nuclear factor kappa-B (NF-kB) is an important transcription factor in most organ systems and is often implicated in the harmful effects of cardiac injury. Read More

Am J Ophthalmol Case Rep 2018 Jun 2;10:233-235. Epub 2018 Mar 2.

Department of Ophthalmology, Columbia University Medical Center, New York, N.Y., United States.

Purpose: Since its report in one patient more than 70 years ago, digitalis-induced colored muscae volitantes have not surfaced again in the literature. We report here a case of digoxin induced colored floaters.

Observations: An 89-year-old man on 0. Read More

J Electrocardiol 2018 May - Jun;51(3):450-451. Epub 2018 Feb 8.

Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States. Electronic address:

This report describes a digitalis-induced regular fascicular ventricular tachycardia characterized by marked QRS alternans a manifestation not usually associated with this arrhythmia. The striking alternation of QRS configuration suggested alternating ventricular activation from either a single focus with two exits in distal branches of the left anterior fascicle or 2 different foci localized in the Purkinje-myocardial network of the left anterior fascicle. Read More

Am J Emerg Med 2018 Apr 8;36(4):735.e1-735.e3. Epub 2018 Jan 8.

Scientific Research and Education Department, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, People's Republic of China.

Bidirectional ventricular tachycardia (BVT) is a rare ventricular tachyarrhythmia. It is usually regular, demonstrating a beat-to-beat alternation in the QRS frontal axis that varies between -20° to -30° and +110°. The tachycardia rate is typically between 140 and 180 beats/min and the QRS is relatively narrow, with a duration of 120 to 150 ms. Read More

Nephron 2018 30;138(2):113-118. Epub 2017 Oct 30.

Department of Medicine E, Sheba Medical Center, Ramat Gan, Israel.

Background: Hypomagnesemia is a known predisposing condition for the appearance of digitalis toxicity. The detection of a genetic form of Mg urinary wasting with hypomagnesemia being caused by a mutation in the γ subunit (FXYD2) of the Na,K-ATPase, the pharmacological target of Digoxin, prompted us to investigate whether Digoxin administration increases urinary Mg excretion.

Methods: Two groups of subjects, with rapid atrial fibrillation, received intravenous Digoxin (n = 9) or verapamil (n = 8), for heart rate control. Read More

Curr Pharm Des 2017 ;23(34):5104-5114

Abant Izzet Baysal University, Faculty of Agricultural and Natural Sciences, Department of Horticulture, 14030 Bolu, Turkey.

The genus Digitalis L. containing species, commonly known as the "foxglove", is the main source of cardenolides, which have various pharmacological properties effective against certain pathological conditions including myocardial infarction, arterial hypertension, cardiac dysfunction, angina, and hypertrophy. Togehter with a prime effect of controlling the heart rhythm, many workers demonstrated that lanatoside C and some other cardiac glycosides are effective in several cancer treatments such as prostate and breast cancers. Read More

J Electrocardiol 2017 Nov - Dec;50(6):909-911. Epub 2017 Jul 12.

Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon. Electronic address:

A 38-year-old healthy male presented with vomiting and profuse diarrhea, associated with blurry and yellow coloration of the vision (xanthopsia). Laboratory workup was unremarkable, except for hyperkalemia (K 5.2 mEq/L) and mildly elevated troponin level 0. Read More

Basic Clin Pharmacol Toxicol 2017 Dec 10;121(6):526-530. Epub 2017 Jul 10.

Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.

The I channel inhibitor ivabradine is recommended for treatment of heart failure but also affects potassium currents and thereby prolongs ventricular repolarization. The aim of this study was to examine the electrophysiological effects of ivabradine on digitalis-induced ventricular arrhythmias. Thirteen rabbit hearts were isolated and Langendorff-perfused. Read More