Although digitalis has been honored for nearly two centuries as the drug of choice for heart failure, its use remains controversial for the left ventricular failure that often complicates acute myocardial infarction. Its efficacy is poorly defined and has been subject to some doubt.1 Of particular concern has been the widely held but not undisputed belief that the acutely infarcted heart is especially sensitive to the toxic effects of digitalis glycosides, most notably their potential to produce arrhythmias. Two studies recently reported in The American Journal of Cardiology illustrate some of the basis for these uncertainties and also provide at least a degree of perspective to the problems.
Hodges and colleagues2 measured the hemodynamic effects of intravenously administered digoxin to ten patients with early myocardial infarction and mild left ventricular failure. They demonstrated a positive inotropic effect in four patients, but either no response or a worsening of