Digitalis in Heart Failure

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Abstract
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.1,2Accordingly, 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