Factors Modifying the Efficacy of Digitalis

  • Edward K. Chung
  • Lisa S. Chung


Digitalis is one of the oldest and one of the most commonly used drugs in our prac tice. Yet, it is not always possible to determine whether digitalis is definitely indicated or not. Needless to say, two major indications for digitalization include (a) the management of congestive heart failure and (b) most supraventricular tachyarrhythmias, particularly atrial fibrillation with rapid ventricular response, provided that the above-mentioned are not digitalis-induced (11). On the other hand, a true contraindication to digitalis is digitalis intoxication (11).


Atrial Fibrillation Acute Myocardial Infarction Atrial Flutter Mitral Stenosis Constrictive Pericarditis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alexander, S. and Ping, W. C. Fatal ventricular fibrillation during carotid stimulation. Am. J. Cardiol., 18:289, 1966.PubMedCrossRefGoogle Scholar
  2. 2.
    Beiser, G. D., Epstein, S. E., Stampfer, M., et al. Studies on digitalis. XVII. Effects of ouabain on the hemodynamic response to exercise in patients with mitral stenosis in normal sinus rhythm. N. Engl. J. Med., 278:131, 1968.PubMedCrossRefGoogle Scholar
  3. 3.
    Bilson, J. S. and Schemm, F. R. Digitalis and ventricular tachycardia. Circulation, 2:278, 1950.CrossRefGoogle Scholar
  4. 4.
    Braudo, M. and Keith, J. D. The value of digitalis in the respiratory distress syndrome: A con trolled study. J. Pediatr., 74:310, 1969.PubMedCrossRefGoogle Scholar
  5. 5.
    Braunwald, E., Bloodwell, R. D., Goldber, L. I., et al. Studies on digitalis. IV. Observations in man on the effect of digitalis preparations on the contractility of the nonfailing heart and on total vascular resistance. J. Clin. Invest., 40:52, 1961.PubMedCrossRefGoogle Scholar
  6. 6.
    Braunwald, E., Brockenbrough, E. C., and Frye, R. L. Studies on digitalis. V. Comparison of the effects of ouabain on left ventricular dynamics in valvular aortic stenosis and hypertrophic subaortic stenosis. Circulation, 26:166, 1962.PubMedCrossRefGoogle Scholar
  7. 7.
    Braunwald, E. and Klocke, F. J. Digitalis. Ann. Rev. Med., 16:371, 1965.CrossRefGoogle Scholar
  8. 8.
    Castellanos, A. Jr., Lemberg, L., Cenurion, M. J., and Berkovits, B. V. Concealed digitalis-induced arrhythmias unmasked by electrical stimulation of the heart. Am. Heart J., 73:484, 1967.PubMedCrossRefGoogle Scholar
  9. 9.
    Chung, E. K. Electrocardiography: Practical Applications with Vectorial Principles. Hagerstown, Harper and Row, 1974.Google Scholar
  10. 10.
    Appraisal of multifocal atrial tachycardia. Br. Heart J., 33:500, 1971.CrossRefGoogle Scholar
  11. 11.
    Digitalis Intoxication. Amsterdam, Excerpta Medica, 1969.Google Scholar
  12. 12.
    Constant, J. Digitalis in myocardial infarction, New York State J. Med., 70:650, 1970.Google Scholar
  13. 13.
    Dall, J. L. C. Digitalis intoxication in elderly patients. Lancet, 2:194, 1965.CrossRefGoogle Scholar
  14. 14.
    Doherty, J. E. Digitalis in congestive heart failure. Mod. Treat., 2:278, 1965.Google Scholar
  15. 15.
    Flanigan, W. J., Perkins, W. H., et al. Studies with tritiated digoxin in anephric human subjects. Circulation, 35:298, 1967.PubMedCrossRefGoogle Scholar
  16. 16.
    Perkins, W. H., and Wilson, M. C. Studies with tritiated digoxin in renal failure. Am. J. Med., 37:536, 1964.PubMedCrossRefGoogle Scholar
  17. 17.
    Engel, T. R. and Schaal, S. F. Digitalis in the sick sinus syndrome. The effects of digitalis on sinoatrial automaticity and atrioventricular conduction. Circulation, 48:1201, 1973.Google Scholar
  18. 18.
    Ewy, G. A., Kapadia, G. G., Yao, L., Lullin, M., and Marcus, F. I. Digoxin metabolism in the elderly. Circulation, 39:449, 1969.PubMedCrossRefGoogle Scholar
  19. 19.
    Marcus, F. I. Digitalis therapy in the aged. Family Physician, 1:81, 1970.Google Scholar
  20. 20.
    Greenspan, K. and Steinmetz, E. Digitalis and Potassium: pharmacodynamic relationship. In Dreifus, L. S. and Likoff, W. eds. Mechanisms and Therapy of Cardiac Arrhythmias. New York, Grune and Stratton, 1968.Google Scholar
  21. 21.
    Greenwood, R. J. and Dupler, D. A. Death following carotid sinus pressure. J.A.M.A., 181:605, 1962.PubMedCrossRefGoogle Scholar
  22. 22.
    Hilal, and Massumi, R. Fatal ventricular fibrillation after carotid sinus stimulation. N. Engl. J. Med., 275:157, 1966.PubMedCrossRefGoogle Scholar
  23. 23.
    Jelliffe, R. W. Factors to consider in planning digoxin therapy. J. Chron. Dis., 24:407, 1971.PubMedCrossRefGoogle Scholar
  24. 24.
    Karliner, J. S. and Braunwald, E. Present status of digitalis treatment of acute myocardial infarc tion. Circulation, 46:891, 1972.CrossRefGoogle Scholar
  25. 25.
    Kleiger, R. and Lown, B. Cardioversion and digitalis. II. Clinical studies. Circulation, 33:878, 1966.CrossRefGoogle Scholar
  26. 26.
    Lown, B., Black, H., and Moore, F. D. Digitalis, electrolytes, and surgical patient. Am. J. Cardiol., 6:309, 1960.PubMedCrossRefGoogle Scholar
  27. 27.
    Mclntosh, H. D. and Morris, J. J., Jr. Problems in the use of digitalis in the management of congestive heart failure. Prog. Cardiovasc. Dis., 7:360, 1965.CrossRefGoogle Scholar
  28. 28.
    Neff, M. S., Mendelssohn, S., Kim, K. E., et al. Magnesium sulfate in digitalis toxicity. Am. J. Cardiol., 29:377, 1972.PubMedCrossRefGoogle Scholar
  29. 29.
    Neil, C. A. The use of digitalis in infants and children. Prog. Cardiovasc. Dis., 7:399, 1965.CrossRefGoogle Scholar
  30. 30.
    Ogilvie, R. I. and Ruedy, J. An educational program in digitalis therapy. J.A.M.A., 222:50, 1972.PubMedCrossRefGoogle Scholar
  31. 31.
    Porus, R. L. and Marcus, F. I. Ventricular fibrillation during carotid-sinus stimulation. N. Engl. J. Med., 268:1338, 1963.PubMedCrossRefGoogle Scholar
  32. 32.
    Rahimtoola, S. H. and Gunnar, R. M. Digitalis in acute myocardial infarction: help or hazard? Ann. Intern. Med., 82:234, 1975.Google Scholar
  33. 33.
    Rutkowski, M. M., Coken, S. N., and Doyle, E. F. Drug therapy of heart disease in pediatric patients. II. The treatment of congestive heart failure in infants and children with digitalis preparations. Am. Heart J., 86:270, 1973.PubMedCrossRefGoogle Scholar
  34. 34.
    Sedeman, W. A. Current concept-diagnosis and treatment of digitalis toxicity. N. Engl. J. Med., 273:35, 1965.CrossRefGoogle Scholar
  35. 35.
    Seller, R. H. The role of magnesium in digitalis toxicity. Am. Heart J., 82:551, 1971.PubMedCrossRefGoogle Scholar
  36. 36.
    Cangiano, J., Kim, K. E., et alDigitalis toxicity and hypomagnesemia. Am. Heart J., 79:57, 1970.PubMedCrossRefGoogle Scholar
  37. 37.
    Selzer, A. The use of digitalis in acute myocardial infarction. Prog. Cardiovasc. Dis., 10:518,1968.PubMedCrossRefGoogle Scholar
  38. 38.
    Somylo, A. P. The toxicology of digitalis. Am. J. Cardiol., 5:523, 1960.CrossRefGoogle Scholar
  39. 39.
    Surawicz, B. and Lepeschkin, E. The electrocardiographic pattern of hypopotassemia with and without hypocalcemia. Circulation, 8:801, 1953.PubMedCrossRefGoogle Scholar
  40. 40.
    Werkö, L. The use of digitalis in mitral stenosis without right heart failure. Prog. Cardiovasc. Dis., 7:284, 1964.CrossRefGoogle Scholar
  41. 41.
    Wright, S. E. The Metabolism of Cardiac Glycosides. Springfield, III., Charles C. Thomas, 1960.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1976

Authors and Affiliations

  • Edward K. Chung
  • Lisa S. Chung

There are no affiliations available

Personalised recommendations