Effects of digitalis glycosides on the systemic arterial and venous system: clinical importance in the pathophysiology of congestive heart failure
Although the digitalis glycosides have been employed widely in clinical medicine for two centuries as the principal drug in the treatment of congestive heart failure, their pharmacologic principles have become established on a firm scientific basis only within the past three decades. The observation that the digitalis-induced stimulation of the force of contraction of the normal human heart is not translated into an increase in cardiac output (7), suggests possible extracardiac vascular effects of the glycosides (5). Indeed, studies in experimental animals have shown that the glycosides exert direct systemic vasoconstriction (10) and this finding has been extended to the peripheral arterial tree of patients during cardiopulmonary bypass in the course of heart operations (1). The purpose of this report is to delineate the clinical alterations produced by digitalis on the resistance vessels (systemic arterioles) and the capacitance beds (systemic veins) of the peripheral circulation (8), and then clarify the significance of these changes relative to the pathophysiology and treatment of congestive heart failure (9).
KeywordsCardiac Output Congestive Heart Failure Forearm Blood Flow Digitalis Glycoside Venous Tone
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- 1.Braunwald E, Bloodwell RD, Goldberg LI, Morrow AG (1961) Studies on digitalis. IV: Observations in man on the effects of digitalis preparations on the contractility of the non-failing heart and on total vascular resistance. J Clin Invest 40: 52–60Google Scholar
- 2.Braunwald E, Chidsey CA, Pool PE, Sonnenblick EH, Ross J Jr, Mason DT, Spann JF, Covell JW (1966) Congestive heart failure: Biochemical and physiological considerations. Ann Int Med 64: 904–925Google Scholar
- 3.Covell JW, Braunwald E, Ross J Jr (1966) Studies on digitalis. XVI. Effects on myocardial oxygen consumption. J Clin Invest 45: 1535–1542Google Scholar
- 4.DeMots H, McAnulty J, Porter G, Rahimtoola S (1975) Effects of rapid and slow infusion of ouabain on systemic and coronary vascular resistance in patients without heart failure. Circulation 52 (Suppl II): 77Google Scholar
- 7.Mason DT, Braunwald E (1963) Studies on digitalis. IX: Effects of ouabain on the nonfailing human heart. J Clin Invest 42: 1105–1115Google Scholar
- 8.Mason DT, Braunwald E (1964) Studies on digitalis. X: Effect of ouabain on forearm vascular resistance and venous tone is normal subjects and in patients in heart failure. J Clin Invest 43: 532–543Google Scholar
- 9.Mason DT, Spann JF Jr, Zelis R (1969) New developments in the understanding of the actions of the digitalis glycosides. Prog. Cardiovas Dis 6: 443–478Google Scholar
- 10.Ross J Jr, Braunwald E, Waldhausen JA (1960) Studies on digitalis. II: Extracardiac effects on venous return and on the capacity of the peripheral vascular bed. J Clin Invest 39: 937–942Google Scholar