[Controversies on digitalis]

The introduction of newer drugs with effective cardiovascular action to clinical practice has reduced dependence on digitalis compounds. This tendency has been further justified by statements to the effect that consistently satisfactory results can be obtained with alternative drugs; that the inotropic action of digitalis is not evident in patients with normal sinus rhythm; that digitalis increases myocardial oxygen consumption, and finally that the high incidence of intoxication should limit its use. The present article reviews the use of alternative agents; the inotropic effects of digitalis in the presence of sinus rhythm; the implications of the use of drugs augmenting contractility upon total myocardial performance and oxygen consumption, and the factors pertinent in favoring digitalis toxicity. Digitalis continues to be a useful agent in the treatment of heart failure, either in patients with atrial fibrillation or in sinus rhythm. It may well be administered in addition to diuretics, vasodilators or fosfodiesterase inhibitors. Digitalis toxicity can be minimized by considering factors enhancing such complication or conditions where its use is ineffective.