Related Experiment Videos
Digitalis: is it useful in congestive heart failure in patients in normal sinus rhythm?
1University of California School of Medicine, San Francisco General Hospital.
Insights
Digoxin remains controversial for chronic heart failure patients in normal sinus rhythm. However, some patients, particularly those with an S3 gallop and enlarged left ventricle, benefit from its positive inotropic effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The clinical utility of digoxin for patients with chronic congestive heart failure (CHF) in normal sinus rhythm is debated.
- While some patients tolerate digoxin withdrawal without issue, a significant subgroup (up to 30%) experiences clinical deterioration.
Purpose of the Study:
- To evaluate the persistent benefits and specific patient subgroups that benefit from digoxin therapy in chronic CHF.
- To highlight digoxin's unique role as an oral positive inotropic agent for CHF management.
Main Methods:
- This study reviews existing evidence on digoxin's efficacy in CHF patients.
- Analysis focuses on clinical deterioration upon withdrawal and specific echocardiographic and physical findings associated with benefit.
Main Results:
- A subset of CHF patients (up to 30%) shows clinical decline when digoxin is discontinued.
- Patients presenting with an S3 gallop and enlarged left ventricle are identified as likely responders to digoxin.
- Evidence supports a persistent, chronic positive inotropic effect of digoxin in CHF.
Conclusions:
- Digoxin provides a sustained benefit for specific CHF patients, particularly those with an S3 gallop and enlarged left ventricle.
- As the sole chronic oral positive inotropic agent that increases stroke volume, digoxin remains a valuable therapeutic option for managing congestive heart failure.
Abstract:
The value of digoxin in the patient in normal sinus rhythm with chronic congestive heart failure continues to be controversial. Although many patients taking digoxin have no clinical deterioration after its discontinuance, there is a subgroup of patients (up to 30% of the total group) who demonstrate clinical deterioration on digoxin withdrawal. Patients with an S3 gallop and an enlarged left ventricle are especially likely to benefit from digoxin therapy. Furthermore, there is good evidence in patients with congestive heart failure that there is a persistent, chronic, positive inotropic effect with digoxin. Since digitalis is the only presently available, chronic, oral positive inotropic drug capable of increasing stroke volume at any given filling pressure, it should be used in patients with congestive heart failure.