doi: 10.1161/01.CIR.0000132482.95686.87
(Circulation. 2004;109:2959-2964.)
© 2004 American Heart Association, Inc.
Clinician Updates |
Digoxin in the Management of Cardiovascular Disorders
From the Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.G.); the Division of Cardiology, University of North Carolina, Chapel Hill, NC (K.F.A.); and the Division of Cardiology, Boston University, Boston, Mass (W.S.C.).
Correspondence to Mihai Gheorghiade, MD, Northwestern University Feinberg School of Medicine, Galter 10-240, 201 East Huron St, Chicago, IL 60611-2908. E-mail m-gheorghiade@northwestern.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
"After all, in spite of opinion, prejudice or error, time will fix the real value upon this discovery."— Sir William Withering, Birmingham, July 1, 1785
Case 1: A 45-year-old man in sinus rhythm, with an ejection fraction of 20%, normal coronaries, and normal renal function is receiving captopril 50 mg 3 times daily, carvedilol 25 mg and furosemide 40 mg twice daily, and spironolactone 25 mg daily. Despite these therapies, he continues to complain of dyspnea with minimal exertion. There are jugular venous distention, rales, and ankle edema. Oral digoxin, 0.125 mg daily, is added. After 3 weeks of maintenance therapy with digoxin, the patient feels better.
Case 2: A 70-year asymptomatic woman in sinus rhythm, with coronary artery disease and ejection fraction of 35% is receiving once a day enalapril 10 mg, metoprolol succinate 200 mg, digoxin 0.125 mg, and furosemide 20 mg. There are no signs of heart failure. Six months after digoxin discontinuation she continues to remain asymptomatic.
Historical Perspectives
As far back as the ancient Egyptians, cultures were known to have used medicinal plants containing cardiac glycosides. It was not until 1542 that the German scholar Fuchsius coined the now common term digitalis for the foxglove plant. Since 1785, when Sir William Withering published his textbook1 on the "account of the foxglove," physicians have used digitalis preparations to treat edematous states, irregular heartbeats, and chronic heart failure (HF). According to Withering, digitalis was believed to slow heart rate in patients with irregular pulse and result in diuresis.
Mechanism of Action
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