Ventricular Function and Indications for Digitalis

  • D. T. Mason
  • R. R. Miller
Conference paper
Part of the International Boehringer Mannheim Symposia book series (BOEHRINGER)

Abstract

The digitalis glycosides have been employed widely in clinical medicine for nearly two centuries as the principal drug in the treatment of congestive heart failure. Many important advances in the past few years have considerably improved our understanding of their physiologic and subcellular mechanisms of action and their pharmacodynamics and application in patients (1). The beneficial effects of digitalis in patients with congestive heart failure result from its direct stimulation of the depressed contractile state. Digitalis augments the low cardiac output and reduces the elevated ventricular end-diastolic pressure of the dysfunctioning heart (Fig. 1). Thus, the glycoside improves the fundamental physiologic defect causing ventricular failure (2), depressed contractility, and this increase in contractile state allows a lesser need for Frank-Starling preload compensation, so that a normal cardiac output can be delivered at a substantially less elevated ventricular filling pressure. Although there is now general agreement that digitalis stimulates the force of contraction of the failing myocardium, there has been considerable confusion about its effects on the nonfailing heart. This problem has recently been resolved by evidence that the glycoside directly elevates the contractile state of the normal ventricle (3), although the increased contractile state is not translated into a rise of cardiac output.

Keywords

Depression Expense Cardiol Glycoside Dial 

Ventrikelfunktiori und Indikationen für Digitalis

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mason, D.T.: Digitalis pharmacology and therapeutics: Recent advances. Ann. Int. Med. 80, 520–530 (1974)PubMedGoogle Scholar
  2. 2.
    Mason, D.T.: Regulation of cardiac performance in clinical heart disease: interactions between contractile state, mechanical abnormalities and ventricular compensatory mechanisms. Amer. J. Cardiol. 32, 437–448 (1973)PubMedCrossRefGoogle Scholar
  3. 3.
    Mason, D.T., Braunwald, E.: Studies on digitalis. IX. Effects of ouabain on the nonfailing human heart. J. clin. Invest. 42, 1105–1111, (1963)PubMedCrossRefGoogle Scholar
  4. 4.
    Mason, D.T., Braunwald, E.: Digitalis: new facts about an old drug. Amer. J. Cardiol. 22, 151–161 (1968)PubMedCrossRefGoogle Scholar
  5. 5.
    Mason, D.T., Braunwald, E.: Studies on digitalis. X. Effects of ouabain on forearm vascular resistance and venous tone in normal subjects and in patients in heart failure. J. clin. Invest. 43, 532–543 (1964)PubMedCrossRefGoogle Scholar
  6. 6.
    Covell, J.W., Braunwald, E., Ross, J. Jr., Sonnenblick, E.: Studies on digitalis. XVI. Effects on myocardial oxygen consumption. J. clin. Invest. 45, 1535–1542 (1966)PubMedCrossRefGoogle Scholar
  7. 7.
    Langer, G.A.: Effects of digitalis on myocardial ionic exchange. Circulation 46, 180–187 (1972)PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1976

Authors and Affiliations

  • D. T. Mason
  • R. R. Miller

There are no affiliations available

Personalised recommendations