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The clinical value of digoxin in patients with heart failure and sinus rhythm
Insights
For patients with congestive heart failure in sinus rhythm, diuretics effectively manage edema. Adding digoxin to diuretics did not improve exercise capacity in this study.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) management often involves addressing fluid overload.
- Diuretics like frusemide are standard for edema reduction in CHF patients.
- The role of digoxin in improving exercise capacity in CHF patients with sinus rhythm, when edema is controlled, requires further investigation.
Observation:
- Six patients with CHF (myocardial infarction or cardiomyopathy) in sinus rhythm received frusemide for edema.
- After achieving 'dry' weight, patients underwent exercise testing with and without digoxin added to frusemide.
- One patient withdrew due to increased angina and premature beats upon digoxin withdrawal.
Findings:
- Five patients completed the study, showing no significant improvement in symptoms or exercise capacity (workload, heart rate, ventilation) with digoxin addition.
- Digoxin withdrawal in one patient led to adverse cardiac events, suggesting a potential role in maintaining stability for some.
Implications:
- For CHF patients in sinus rhythm with edema controlled by diuretics, digoxin does not appear to enhance exercise capacity.
- Initial treatment for such patients should prioritize diuretics for managing salt and water retention.
- Further research may explore digoxin's specific benefits in CHF subsets beyond fluid management.
Abstract:
Six patients in sinus rhythm with congestive heart failure due to either myocardial infarction or cardiomyopathy, were given oral frusemide to eliminate oedema. Symptomatic relief occurred as body weight was reduced, and after a 'dry' basal weight had been achieved, progressive-load exercise testing was done to examine any benefit that derived from adding oral digoxin to the diuretic. Three pairs of sub-maximal exercise tests were done at intervals over three months, and the responses of each patient when using digoxin and diuretics were compared with those when using diuretics alone. One patient did not complete this study, because more frequent premature beats and increased angina followed the withdrawal of digoxin. For the five patients who completed three pairs of tests, there was no significant change in symptoms, in workload achieved, or in heart rate, respiratory rate, ventilation and respiratory quotient, whether digoxin was added or removed. It is concluded that in these patients where salt and water retention was controlled with diuretics, digoxin did not improve the capacity for exercise, and it is suggested that for such patients with myocardial disease in sinus rhythm, treatment should begin with diuretics.