Digitalis (Cardiac Poison) PDF

DIGITALIS (CARDIAC POISON) DR JAYANTI JAIN (BAMS, MD ) ASSISTANT PROFESSOR DR VASANT PARIKH AYURVEDIC MEDICAL COLLEGE, VADNAGRA  INTRODUCTION  Botanical Name – Digitalis purpurea  Family- Scrophul...

DIGITALIS (CARDIAC POISON) DR JAYANTI JAIN (BAMS, MD ) ASSISTANT PROFESSOR DR VASANT PARIKH AYURVEDIC MEDICAL COLLEGE, VADNAGRA  INTRODUCTION  Botanical Name – Digitalis purpurea  Family- Scrophulariaceae  Vernacular Name : 1. Hindi Name – Tilpushpi 2. English Name – Foxglove, common foxglove, purple foxglove  Synonyms- Hritpatri  Toxic Part- Roots, seeds and leaves 2  TOXIC CHEMICAL CONSTITUENT (ACTIVE PRINCIPLE)  Entire plant is toxin, containing over thirty cardiac and steroidal glycosides.  The roots , leaves and seeds of digitalis contain-  Digitoxin,  Digitalin,  Digitalein  Digitonin 3  RAS PANCHAK  Ras – Tikt  Guna – Laghu, Ruksh  Virye – Sheeta  Vipaka- Katu 4  MODE OF ACTION The glycosides act directly on the heart muscle (prolong diastolic period) and improve the function of the failing heart. In toxic doses, excitability is increased with extrasystoles (premature ventricular contractions ). 5  SIGN AND SYMPTOMS GIT: Anorexia, nausea, vomiting, diarrhea. CARDIAC: Arrhythmias: extrasystoles, ventricular tachycardia and fibrillation, SA· block, A V block. ENDOCRINE: Gynecomastia. VISUAL: Transient amblyopia (lazy eye) , photophobia, diplopia, blurring, scotomata, halos. SKIN: Urticaria. CNS: Headache, fatigue, muscle weakness, neuro-psychiatric disorders, confusion, anxiety, depression, disorientation, drowsiness, delirium, hallucinations, trigeminal neuralgia. Death occurs from cardiovascular collapse 6  FATAL DOSE & FATAL PERIOD FATAL DOSE FATAL PERIOD   1–24 h. Digitalis: 2–3 g.  Digoxin: 5 mg.  Digitalin: 15–20 mg  Powdered leaves: 2.5 g. 7  TREATMENT  ECG monitoring is necessary as a guide to treatment.  Gastric lavage is done with a solution of tannic acid.  Activated charcoal is given.  Purgatives may be given.  Atropine is given in a dose of 0.6 mg IV to treat bradycardia.  Potassium chloride may be given to reduce extrasystoles.  Specific antidote for cardiac arrhythmias is lignocaine 100 mg IV or novocaine or propranolol.  Trisodium EDTA may help to lower serum calcium.  Symptomatic treatment. 8  POSTMORTEM EXAMINATION  Nonspecific changes are seen.  There may be irritation of the gastric mucosa, and digitalis leaves or seeds may be found in the stomach 9  MEDICO -LEGAL ASPECTS   Accidental poisoning due to overdose of a medicinal preparation or from eating leaves by mistake  It is a cumulative poison, and persons taking it for a long time may suddenly develop symptoms of poisoning.  Homicidal poisoning cases may be seen, and no suspicion of poisoning may arise in such cases as it will simulate heart disease. 10