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July 10, 1981, Vol 246, No. 2 >
ARTICLE | July 10, 1981

Digitalis in Heart Failure: Title and subTitle BreakFarewell to the Foxglove? FREE

Marcis T. Sodums, MD; Richard A. Walsh, MD; Robert A. O'Rourke, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Cardiology Division, Department of Medicine, The University of Texas Health Science Center, San Antonio, TX 78284 (Dr Sodums).


JAMA. 1981;246(2):158-160. doi:10.1001/jama.1981.03320020050026
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References

AFTER more than 200 years of clinical use, the role of digitalis therapy in the management of acute and chronic congestive heart failure and its effectiveness compared with vasodilator therapy is being questioned. This controversy results from the difficulty in demonstrating the salutary effect of digitalis on overall cardiac performance, although the positive inotropic effect of digitalis on left ventricular function, both in the normal and depressed ventricle, has been well established.1,2 Accordingly, we will review the evidence for the beneficial effects of digitalis in acute (eg, myocardial infarction) and chronic heart failure and the relation between digitalis therapy and vasodilator therapy in these conditions.

Net cardiac pump performance results from the complex interaction of several opposing factors3 (Figure). Cardiac output is determined by the heart rate, left ventricular filling volume or preload, left ventricular afterload or resistance to left ventricular ejection (approximated by systolic blood pressure), and

REFERENCES

1 +
Braunwald E, Bloodwell RD, Goldberg LI, et al:  Studies on digitalis: IV. Observations in man on the effects of digitalis preparations on the contractility of the non-failing heart and on total vascular resistance . J Clin Invest 1961;; 40:52-59.
2 +
Bloomfield RA, Rapoport B, Milnor JP, et al:  The effects of the cardiac glycosides upon the dynamics of the circulation in congestive heart failure . J Clin Invest 1948;;27:588-599.
3 +
Braunwald E: Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1980;; pp 413-452.
4 +
Klein M, Nejad NS, Lown B, et al:  Correlation of the electrical and mechanical changes in the dog heart during progressive digitalization . Circ Res 1971;;29:635-645.
5 +
Garan H, Smith TW, Powell JW Jr:  Mechanism of vasoconstrictor effect of digoxin in coronary and skeletal muscle circulation , abstracted. Fed Proc 1973;;32:718.
6 +
O'Rourke RA, Henning H, Theroux P, et al:  Favorable effects of orally administered digox in on left heart size and ventricular wall motion in patients with previous myocardial infarction . Am J Cardiol 1976;;37:708-715.
7 +
Cohn K, Selzer A, Kersh ES, et al:  Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease . Am J Cardiol 1975;;35:461-468.
8 +
Firth BG, Dehmer GJ, Corbett JR, et al:  Effect of chronic oral digoxin therapy on ventricular function at rest and peak exercise in patients with ischemic heart disease . Am J Cardiol 1980;;46:481-490.
9 +
Morrison J, Coromilas J, Robbins M, et al:  Digitalis and myocardial infarction in man . Circulation 1980;;62:8-16.
10 +
Rahimtoola SH, Gunnar RM:  Digitalis in acute myocardial infarction: Help or hazard? Ann Intern Med 1975;;82:234-240.
11 +
Lown B, Klein MD, Barr I, et al:  Sensitivity to digitalis drugs in acute myocardial infarction . Am J Cardiol 1972;;30:388-395.
12 +
Miller RR, Vismara LA, Williams DO, et al:  Pharmacological mechanisms for left ventricular unloading in clinical congestive heart failure: Differential effects of nitroprusside, phenotolamine, and nitroglycerin on cardiac function and peripheral circulation . Circ Res 1976;;39:127-133.
13 +
Goldberg S, Mann T, Grossman W:  Nitrate therapy of heart failure in valvular heart disease: Importance of resting level of peripheral vascular resistance in determining cardiac output response . Am J Med 1978;;65:161-166.
14 +
Packer M, Meller J, Gorlin R, et al:  Hemodynamic and clinical tachyphylaxis to prazosin-mediated afterload reduction in severe chronic congestive heart failure . Circulation 1979;;59:531-539.
15 +
Thadani U, Manzari D, Parker JO, et al:  Tolerance to the circulatory effects of oral isosorbide dinitrate: Rate of development and cross-tolerance to glyceryl trinitrate . Circulation 1980;;61:526-535.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Braunwald E, Bloodwell RD, Goldberg LI, et al:  Studies on digitalis: IV. Observations in man on the effects of digitalis preparations on the contractility of the non-failing heart and on total vascular resistance . J Clin Invest 1961;; 40:52-59.
2 +
Bloomfield RA, Rapoport B, Milnor JP, et al:  The effects of the cardiac glycosides upon the dynamics of the circulation in congestive heart failure . J Clin Invest 1948;;27:588-599.
3 +
Braunwald E: Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1980;; pp 413-452.
4 +
Klein M, Nejad NS, Lown B, et al:  Correlation of the electrical and mechanical changes in the dog heart during progressive digitalization . Circ Res 1971;;29:635-645.
5 +
Garan H, Smith TW, Powell JW Jr:  Mechanism of vasoconstrictor effect of digoxin in coronary and skeletal muscle circulation , abstracted. Fed Proc 1973;;32:718.
6 +
O'Rourke RA, Henning H, Theroux P, et al:  Favorable effects of orally administered digox in on left heart size and ventricular wall motion in patients with previous myocardial infarction . Am J Cardiol 1976;;37:708-715.
7 +
Cohn K, Selzer A, Kersh ES, et al:  Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease . Am J Cardiol 1975;;35:461-468.
8 +
Firth BG, Dehmer GJ, Corbett JR, et al:  Effect of chronic oral digoxin therapy on ventricular function at rest and peak exercise in patients with ischemic heart disease . Am J Cardiol 1980;;46:481-490.
9 +
Morrison J, Coromilas J, Robbins M, et al:  Digitalis and myocardial infarction in man . Circulation 1980;;62:8-16.
10 +
Rahimtoola SH, Gunnar RM:  Digitalis in acute myocardial infarction: Help or hazard? Ann Intern Med 1975;;82:234-240.
11 +
Lown B, Klein MD, Barr I, et al:  Sensitivity to digitalis drugs in acute myocardial infarction . Am J Cardiol 1972;;30:388-395.
12 +
Miller RR, Vismara LA, Williams DO, et al:  Pharmacological mechanisms for left ventricular unloading in clinical congestive heart failure: Differential effects of nitroprusside, phenotolamine, and nitroglycerin on cardiac function and peripheral circulation . Circ Res 1976;;39:127-133.
13 +
Goldberg S, Mann T, Grossman W:  Nitrate therapy of heart failure in valvular heart disease: Importance of resting level of peripheral vascular resistance in determining cardiac output response . Am J Med 1978;;65:161-166.
14 +
Packer M, Meller J, Gorlin R, et al:  Hemodynamic and clinical tachyphylaxis to prazosin-mediated afterload reduction in severe chronic congestive heart failure . Circulation 1979;;59:531-539.
15 +
Thadani U, Manzari D, Parker JO, et al:  Tolerance to the circulatory effects of oral isosorbide dinitrate: Rate of development and cross-tolerance to glyceryl trinitrate . Circulation 1980;;61:526-535.

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