Digitalis In Heart Failure Research Articles

Digitalis in heart failure: declining use and ongoing outcome trials.

Reasons for the decline in use of digitalis in heart failure, importance of serum digoxin concentrations, and characteristics of two ongoing trials with digitalis in heart failure.

Overexpression of the Na+ /Ca2+ exchanger influences ouabain-mediated spontaneous Ca2+ activity but not positive inotropy.

Administration of digitalis in heart failure (HF) increases quality of life but does not carry a prognostic benefit. Digitalis is an indirect inhibitor of the Na+ /Ca2+ exchanger (NCX), which is overexpressed in HF. We therefore used the cardiac glycoside ouabain in Ca2+ imaging experiments and patch-clamp experiments in isolated ventricular myocytes from nonfailing transgenic NCX overexpressor mice (OE). In field-stimulated myocytes, ouabain (1-100μm) increased the amplitude of the Ca2+ transient in OE and wild-type (WT) similarly. Ouabain-mediated spontaneous Ca2+ -activity was significantly more pronounced in OE compared to WT myocytes at higher concentrations (100μm). Also, at very high concentrations (1000μm) of ouabain, the number of cells with hypercontraction leading to cell death was higher in OE. Ouabain (10μm) shortened the action potential duration in both genotypes. Our findings suggest that the proarrhythmic but not the inotropic effects of cardiac glycosides are enhanced by increased NCX expression. This may offer an explanation for the observed lack of prognostic benefit but increased quality of life in HF, which is accompanied by NCX upregulation.

Treatment of heart failure in children

Research in the treatment field of heart failure in children is obviously lagging in that of adult, and its theory and experience are copied from adult results in a large extent.The domestic diagnosis and treatment guideline of heart failure in children is lack.At present, the treating status of digitalis in heart failure of children has declined, meanwhile the neuroendocrine modulation and body volume control draw more attentions.In addition, artificial assist device, continuous renal replacement therapy and stem cell therapy of heart failure in children is gradually paid more interests. Key words: Heart failure; Treatment; Children,

The Management of Madness

Symptom relief is a commendable goal but no proof that a drug corrects anything. Aspirin can often relieve fever and pain, but it does not treat the causes. Medicines prescribed to treat organic diseases — such insulin for diabetes and digitalis for heart failure — have measurable effects that can and must be monitored. Hundreds of syndromes in the Diagnostic and Statistical Manual only confuse any search for cure, but they give symptoms the appearance of ‘recognized medical disorders’. That allows the pharmaceutical industry to advertise psychoactive drugs — analgesics, stimulants, and sedatives — as if they were medicine. Psychoactive drugs are notoriously addictive, which tends to build life-time customers. That is unfortunate for the wide use of drugs, especially stimulants, may contribute to violence.

Digoxin in chronic heart failure

Digitalis purpurea (foxglove) has been used for centuries. It was among the herbal remedies used in ancient Rome, and in the 16th century it was used in Ireland, Germany and England for ‘dropsy’ and other medical conditions. In 1785, William Withering reported on his study of digitalis extract used in 163 hospitalized patients, concluding that its beneficial action was due to effects on the power and motion of the heart. Pure digitoxin was first isolated from foxglove in 1875, and digoxin, the glycoside used today, was first isolated in 1957.1 Evidence to guide optimal management of heart failure continues to evolve, however, and the role of digitalis in heart failure has been called “the oldest continuing controversy in the history of medicine.”2 The articles in this selection provide food for thought on the place of digoxin in modern evidence-based management of heart failure.

Digitalis therapy for patients in clinical heart failure.

The most commonly used preparation of digitalis is digoxin, which is obtained from the leaves of Digitalis lanata , a common flowering plant called “foxglove.” The words digitalis and digoxin in this article are used interchangeably. An exhaustive review published in 19961 cited a large number of references and had detailed data and descriptions of a large number of studies and all early trials. The present article summarizes those data but focuses on and emphasizes data collected since that time. These have been described in detail previously1 and are briefly summarized. ### Inotropic Effects The inotropic effects have been documented in the isolated papillary muscles and in the normal hearts of animals and humans. The inotropic action occurs in both ventricles and in both atria. In the normal heart and in those with coronary artery disease and normal left ventricular (LV) systolic function, with digitalis the LV function curve is moved upward and to the left.1 As a result, LV end-diastolic pressure and LV end-diastolic and end-systolic volumes are reduced, and there is an increase of LV ejection fraction (LVEF).1 ### Patients With Heart Failure In patients with heart failure (HF), digoxin slows the ventricular rate (1) in sinus rhythm because of an improvement in HF and withdrawal of sympathetic stimulation and (2) in atrial fibrillation by increasing parasympathetic tone. The combination of digoxin and carvedilol is superior to digoxin or carvedilol alone.2 ### Peripheral Vessels In normal subjects given intravenous ouabain, there is arterial and venous vasocontriction.3 The vasoconstriction is obviated by administering digoxin slowly over a period of 15 to 20 minutes1; moreover, the vasoconstriction lasts up to 30 minutes. The seminal study of Mason and Braunwald3 showed that in HF, the effects are different. Digitalis produces an increase of blood flow, a decrease of vascular resistance, venodilation, and a …

Heart failure therapy at the turn of the century.

Major changes in the treatment of heart failure have occurred in the last fifty years that have had a dramatic effect on its morbidity and mortality. Over two hundred years have passed since the demonstration of the benefit of digitalis in heart failure to the development of potent loop diuretics. The observation that vasodilators could improve both cardiac function and mortality led to the investigation of the Angiotensin Converting Enzyme Inhibitors (ACEI). Although these agents had significant vasodilator properties, their major benefit appears to be related to their ability to effect remodeling of the failing left ventricle. The most recent randomized clinical trials demonstrate that Beta Adrenergic Blocking agents can provide an incremental effect on both mortality and morbidity when added to therapy with ACEI. Although these agents have improved the outlook for the heart failure patient, they have had very little effect on the improvement of left ventricular function. Future research must be directed at methods to deal with this issue by either changing the contractile properties of the cardiomyocyte by pharmacologic or electrical therapy or by transplanting functional cells that can increase the number of functioning contractile units.

Digitalis in the treatment of heart failure in the elderly. The GIFA study results.

Digitalis glycosides have played an important role in the treatment of patients with heart failure (HF) for more than two centuries. Despite the introduction of new therapeutic strategies in the treatment of HF, and controversies regarding the role of digitalis in HF in sinus rhythm and its effect on mortality, digoxin is one of the most commonly prescribed drugs in the community and in hospital settings, particularly in the elderly. The Italian Group of Pharmacosurveillance in the Elderly (GIFA) monitored 20,047 hospitalized patients in 1988, 1991 and 1993, and found that digoxin was the most frequently prescribed drug in the management of HF. Inappropriate prescriptions of digitalis, defined with standardized criteria, were uncommon, and the mean daily dosage was low. Compared to earlier studies the incidence rate of adverse drug reactions (ADRs) to digoxin, was also low. The reduction in ADRs incidence was probably due to a better understanding of digoxin pharmacokinetics and to a lower daily dosage in the elderly. Nevertheless, digoxin toxicity was significantly more frequent in patients aged >or= 80 years than in those aged < 65 and and 65-79 years. In a multidrug approach to the treatment of chronic HF, digoxin exerts clinical benefits also in patients with sinus rhythm, it is not costly, it is easy to administer, and toxic effects are not common.

Serum Levels and Digoxin Toxicity

To the Editor.— The otherwise useful review of digitalis in heart failure by Sodums and colleagues (1981;246:158) is flawed by the recommendation that a maximal effective, yet safe, dose may be attained by measuring serum levels while considering the factors affecting loading and maintenance doses. One should, of course, consider the factors noted, but the use of serum levels tends to be misleading. The wide overlap in plasma levels of digoxin between patients experiencing toxic effects and those who do not is well known. Moreover, the recent work of Goren and Denes ( Chest 1981; 79:555) indicates that rhythms potentially owing to digitalis intoxication frequently observed during 24-hour monitoring in hospitalized patients and are frequently unrelated to the serum level of digoxin, and appear unlikely to reflect true digitalis intoxication. Estimating the level of digitalis glycosides can, of course, confirm that the patient is actually taking one or another agent.

Digitalis in heart failure. Farewell to the foxglove?

Digitalis in heart failure. Farewell to the foxglove?

PHENOTHIAZINE REDUCTION AS A CAUSE OF REHOSPITALIZATION.

WE RECENTLY studied a group of schizophrenic outpatients to find out if reduction in phenothiazine dosage, ordered by a physician, is a significant cause of readmission to a hospital. Previous controlled studies have shown the deleterious effect, in schizophrenia, of withdrawing phenothiazines.1-8Some of these have been of the type where the phenothiazine was withdrawn and replaced by a placebo1-7with the patient's physician remaining blind. In several of these studies readmission to a hospital has been used as a criterion of deterioration.2-4,8 It might be supposed that when the reduction in dosage is deliberately ordered by a physician, the deleterious results would be less likely than when the drug is capriciously stopped as part of a double-blind, placebo-controlled, experiment. (Analogy with other drugs, such as digitalis for heart failure, or steroids for rheumatoid arthritis, would certainly suggest this.) Forrest, however, has

The treatment of heart failure and the use of digitalis in myocardial infarction

1. (1) To deal accurately with the therapy of heart failure, we must thoroughly understand the condition and the drugs at our command. 2. (2) Treatment of acute left heart failure in myocardial infarction consists primarily of oxygen with anti-foaming therapy, morphine, tourniquets, and digitalis. 3. (3) Treatment of chronic congestive failure in myocardial infarction consists primarily of rest, low-sodium intake, digitalis, oxygen, and mercurial diuretics. 4. (4) The indications for and the actions of digitalis in heart failure following myocardial infarction are discussed. 5. (5) Digitalis should not be given parenterally in myocardial infarction unless acute pulmonary edema exists or there is no other feasible portal of entry. Lanatoside D or Lanoxin is preferred for this and Lanoxin, digitoxin or gitalin is preferred for oral use. 6. (6) The precautions in the use of digitalis, the signs of toxicity, and the therapy of digitalis toxicity are discussed.

Comparison of the tolerance of adults and children to digitoxin.

The utility of digitalis therapy in children is a subject of much controversy. That this group of drugs is not as effective in children as it is in adults is generally accepted, but there is the belief, fairly widely held among those familiar with the problems of heart disease in children, that digitalis therapy may be injurious to children with heart disease and failure. Sutton and Wyckoff1studied the effect of digitalis in heart failure among a group of children and concluded that the drug is useful, and in dosages,approximately similar to those for adults. Jacobsen and Davison2found digitalis effective in children with active carditis and failure, but in larger doses than those required by adults on the basis of body weight. Jezer and Schwartz3gave very large doses of digitalis to a group of children in congestive failure; from this experience they concluded that the

NEW LIGHT ON THE PHARMACODYNAMICS OF HEART FAILURE

Editorial1 September 1949NEW LIGHT ON THE PHARMACODYNAMICS OF HEART FAILUREH. J. L. M.H. J. L. M.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-31-3-524 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSince Withering1 established the empirical fact that the powdered leaves of foxglove were a valuable remedy for the dropsy, many of the pharmacological actions of digitalis have been elucidated. Those that have gained general acceptance are well summarized by Willius2 in three main compartments:(a) digitalis depresses the function of the sino-auricular and the auriculo-ventricular nodes, and a tendency to slowing of the cardiac rate results;(b) it depresses conduction throughout the cardiac muscle, particularly through the auriculo-ventricular bundle, and increases the refractory period in both the auricles and ventricles;(c) it increases the amplitude of cardiac contraction and tends...1 WITHERING W: An account of the foxglove and some of its medicinal uses: with practical remarks on dropsy and other diseases, 1785, M. Swinney, Birmingham. Google Scholar2 WILLIUS FA: The actions of digitalis and indications for its use, Proc. Staff Meet. Mayo Clin., 1938, xiii, 572. Google Scholar3 HARRISONLEONARD TRBW: The effect of digitalis on the cardiac out-put of dogs, and its bearing on the action of the drug in heart disease, Jr. Clin. Invest., 1926-1927, iii, 1. CrossrefGoogle Scholar4 DOCKTAINTER WML: The circulatory changes after full therapeutic doses of digitalis, with a critical discussion of views on cardiac output, Jr. Clin. Invest., 1930, viii, 467. CrossrefGoogle Scholar5 RYTAND DA: The effect of digitalis on the venous pressure of normal individuals, Jr. Clin. Invest., 1933, xii, 847. CrossrefGoogle Scholar6 WOOD P: The action of digitalis in heart failure with normal rhythm, Brit. Heart Jr., 1940, ii, 132. CrossrefGoogle Scholar7 FORSSMANN W: Die Sondierung des rechten Herzens, Klin. Wchnschr., 1929, viii, 2085. CrossrefGoogle Scholar8 COURNANDRANGES AHA: Catheterization of the right auricle in man, Proc. Exper. Biol. and Med., 1941, xlvi, 462. CrossrefGoogle Scholar9 MCMICHAELSHARPEY-SCHAFER JEP: The action of intravenous digoxin in man, Quart. Jr. Med., 1944, xiii, 123. Google Scholar10 HOWARTHMCMICHAELSHARPEY-SCHAFER SJEP: Effects of venesection in low output heart failure, Clin. Sci., 1946, vi, 41. Google Scholar11 KATZMENDLOWITZKAPLAN LNMHA: Action of digitalis on isolated heart, Am. Heart Jr., 1938, xvi, 149. CrossrefGoogle Scholar12 MCMICHAEL J: The pharmacology of the failing heart, Brit. Med. Jr., 1948, ii, 927. CrossrefGoogle Scholar13 HOWARTHMCMICHAELSHARPEY-SCHAFER SJEP: Effects of oxygen, venesection and digitalis in chronic heart failure from disease of the lungs, Clin. Sci., 1947, vi, 187. Google Scholar14 VAQUEZLUTEMBACHER HR: De l'Ouabaine Arnaud, Presse méd., 1928, xxxvi, 129. Google Scholar15 HOWARTHMCMICHAELSHARPEY-SCHAFER SJEP: The circulatory action of theophylline ethylene diamine, Clin. Sci., 1947, vi, 125. Google Scholar16 Leading Article, Brit. Med. Jr., 1948, ii, 947. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1949Volume 31, Issue 3Page: 524-528KeywordsCardiac musclesCardiac ventriclesEdemaHeart failureHeart ratePharmacodynamics ePublished: 1 December 2008 Issue Published: 1 September 1949 PDF downloadLoading ...

CLINICAL EVALUATION OF CEDILANID

Article1 February 1943CLINICAL EVALUATION OF CEDILANIDMAURICE SOKOLOW, M.D., FRANCIS L. CHAMBERLAIN, M.D.MAURICE SOKOLOW, M.D.Search for more papers by this author, FRANCIS L. CHAMBERLAIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-18-2-204 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe pure glycosides of digitalis have been the subject of many recent pharmacological and clinical investigations. Originally all the studies were purely chemical, but they have assumed clinical importance. The crude whole leaf ofDigitalis purpureacommonly used in clinical medicine has never been an ideal therapeutic agent. The various preparations differ widely in composition and potency, and require biological standardization. Furthermore, the U.S.P. product may vary in strength with each revision. For instance, the digitalis in U.S.P. XI is approximately 30 per cent more potent than that in U.S.P. X, and the United States Pharmacopeia allows a 40 per...Bibliography1. GOLD H: Digitalis in heart failure, New York State Jr. Med., 1941, xli, 496. Google Scholar2. SMITH S: II. Digitalis glucosides, Jr. Chem. Soc., 1930, 2478. SMITH, SYDNEY: III. Digitalis glucosides, Jr. Chem. Soc., 1931, 23. CrossrefGoogle Scholar3. STOLL A: The cardiac glycosides, 1937, Pharmaceutical Press, London. Google Scholar4. MOEVISSCHER GKMB: Studies on the native glucosides of digitalis lanata, Jr. Pharmacol. and Exper. Therap., 1938, lxiv, 65. Google Scholar5. WAYNE EJ: Clinical observations on two pure glucosides of digitalis, digoxin and digitalinum verum, Clin. Sci., 1933, i, 63. Google Scholar6. JUNETBIANCHI RM: Etude clinique d'un nouveau digitaligal, le digilande, Rev. méd. de la Suisse Rom., 1939, lix, 139. Google Scholar7. MICHAUD L: L'emptoi du digilanide C en clinique, Schweiz. med. Wchnschr., 1938, xix, 1338. Google Scholar8. GOLDKWITCATTELL HNTM: Studies on purified digitalis glucosides. I. Jr. Pharmacol. and Exper. Therap., 1940, lxix, 177. Google Scholar9. KWITGOLDCATTELL NTHM: Studies on purified digitalis glucosides. II. Jr. Pharmacol. and Exper. Therap., 1940, lxx, 254. Google Scholar10. CATTELLGOLD MH: Studies on purified digitalis glucosides, III. Jr. Pharmacol. and Exper. Therap., 1941, lxxi, 114. Google Scholar11. FAHRLADUE GJ: A preliminary investigation of the therapeutic value of lanatoside C (cedilanid), Am. Heart Jr., 1941, xxi, 133. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: San Francisco, California*Received for publication December 8, 1941.From the Department of Medicine, University of California Medical School, San Francisco.Aided by a grant from the Sandoz Chemical Works, Inc. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPrompt Myocardial Damage Contributes to Hepatic, Renal, and Intestinal Injuries Soon After a Severe Burn in RatsHerzinsuffizienzAnd More on DigitalisSummary of Current TherapyTherapie der HerzinsuffizienzQuantitatives zur Therapie mit HerzglykosidenVergleichende DigitalistherapieAtrial flutterThe Clinical Use of Digitalis PreparationsRecent Advances in Cardiovascular DiseaseCare of the Patient with Chronic Heart Disease 1 February 1943Volume 18, Issue 2Page: 204-213KeywordsGlycosidesUnited States pharmacopeia ePublished: 1 December 2008 Issue Published: 1 February 1943 PDF downloadLoading ...

DIGITALIS IN THE PREVENTION OF RECURRENT CARDIAC FAILURE IN PATIENTS WITH SINUS RHYTHM

Article1 March 1942DIGITALIS IN THE PREVENTION OF RECURRENT CARDIAC FAILURE IN PATIENTS WITH SINUS RHYTHMM. SOKOLOW, M.D., H. B. WEINBERG, M.D., J. L. PLAUT, M.D., L. N. KATZ, M.D.M. SOKOLOW, M.D.Search for more papers by this author, H. B. WEINBERG, M.D.Search for more papers by this author, J. L. PLAUT, M.D.Search for more papers by this author, L. N. KATZ, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-16-3-427 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough digitalis is one of the oldest drugs used in specific cardiac therapy, and probably the most widely used, there is still some dispute as to its indications and value under various circumstances. Opinions range from those recommending that digitalis be administered in all cases of heart disease (Christian,1Cloetta2) to those stating that digitalis has striking value only in cases of auricular fibrillation, and here only by slowing the ventricular rate (Lewis3). That digitalis slows the ventricular rate in auricular fibrillation has been conclusively demonstrated (Mackenzie,5Cushny4). This may improve the efficiency of the heart and produce striking relief...Bibliography1. CHRISTIAN HA: Use of digitalis other than in treatment of cardiac decompensation, Jr. Am. Med. Assoc., 1933, c, 789-792. CrossrefGoogle Scholar2. CLOETTA M: Biochemical action of digitalis, Jr. Am. Med. Assoc., 1929, xciii, 1462-1466. CrossrefGoogle Scholar3. LEWIS T: On cardinal principles in cardiological practice, Brit. Med. Jr., 1919, ii, 621-625. CrossrefGoogle Scholar4. CUSHNY AR: Digitalis and its allies, 1925, Longmans, Green & Co., London. Google Scholar5. MACKENZIE J: Digitalis, Heart, 1910, ii, 273. Google Scholar6. LEWIS T: Diseases of the heart, 1937, 2nd edition, Macmillan Company, New York. Google Scholar7. COTTON TF: Modern methods in diagnosis and treatment of heart disease, Canad. Med. Assoc. Jr., 1926, xvi, 487-492. Google Scholar8. PRATT JH: Digitalis therapy, Jr. Am. Med. Assoc., 1918, lxxi, 618-622. CrossrefGoogle Scholar9. CHRISTIAN HA: Digitalis therapy, Am. Jr. Med. Sci., 1919, clvii, 593-602. Google Scholar10. LUTEN D: Clinical studies of digitalis; effects produced by administration of massive dosage to patients with normal mechanism, Arch. Int. Med., 1924, xxxiii, 251-278. CrossrefGoogle Scholar11. MARVIN HM: Digitalis and diuretics in heart failure with regular rhythm, with especial reference to importance of etiologic classification of heart disease, Jr. Clin. Invest., 1927, iii, 521-539. CrossrefGoogle Scholar12. HARRISONCALHOUNTURLEY TRJAFC: Congestive heart failure; effect of digitalis on dyspnea and on ventilation of ambulatory patients with regular cardiac rhythm, Arch. Int. Med., 1931, xlviii, 1203-1216. CrossrefGoogle Scholar13. GRAVEYPARKINSON CJJ: Digitalis in heart failure with normal rhythm, Brit. Heart Jr., 1939, i, 27-44. Google Scholar14. GOLDDEGRAFF HAC: Studies on digitalis in ambulatory cardiac patients; newer principles of digitalis dosage, Jr. Am. Med. Assoc., 1930, xcv, 1237-1243. CrossrefGoogle Scholar15. WEINSTEINPLAUTKATZ WJLN: Limitations of use of digitalis for ambulatory patients with auricular fibrillation, Am. Jr. Med. Sci., 1940, cxcix, 498-505. CrossrefGoogle Scholar16. HARRISON TR: Failure of the circulation, 1939, 2nd edition, Williams and Wilkins Company, Baltimore. Google Scholar17. FISHBERG AM: Heart failure, 1937, Lea and Febiger, Philadelphia. Google Scholar18. WHITE PD: Heart disease, 1937, 2nd edition, Macmillan Company, New York. Google Scholar19. LUTEN D: The clinical use of digitalis, 1936, Charles C. Thomas Company, Springfield, Illinois. Google Scholar20. LYONSKENNEDYBURWELL RHAJCS: The measurement of venous pressure by the direct method, Am. Heart Jr., 1938, xvi, 675-693. CrossrefGoogle Scholar21. OPPENHEIMERHITZIG BSWM: Use of circulatory measures in evaluating pulmonary and cardiac factors in chronic lung disorders, Am. Heart Jr., 1936, xii, 257-271. CrossrefGoogle Scholar22. : Nomenclature and criteria for diagnosis of diseases of the heart, 1939, 4th edition, New York Heart Assoc., New York. Google Scholar23. PETERSVISSCHER HCMB: Energy metabolism of heart in failure and influence of drugs upon it, Am. Heart Jr., 1936, xi, 273-291. CrossrefGoogle Scholar24. KATZMENDLOWITZKAPLAN LNMHA: Action of digitalis on isolated heart, Am. Heart Jr., 1938, xvi, 149-158. CrossrefGoogle Scholar25. STEWARTDIETRICKCRANEWHEELER HJJENFCH: Action of digitalis in uncomplicated heart disease, Arch. Int. Med., 1938, lxii, 569-592. CrossrefGoogle Scholar26. GOLDCATTELL HM: Mechanism of digitalis action in abolishing heart failure, Arch. Int. Med., 1940, lxv, 263-278. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication September 21, 1940.From the Cardiovascular Department, Michael Reese Hospital, Chicago.Aided by the A. D. Nast Fund for Cardiac Research and the A. B. Kuppenheimer Fund. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byWhen to start digitalis?HerzinsuffizienzReevaluation of Digitalis Efficacy New Light on an Old LeafCYNTHIA D. MULROW, M.D., JOHN R. FEUSSNER, M.D., RAMON VELEZ, M.D.Heart Failure in OutpatientsLong-Term Digitalis Therapy Improves Left Ventricular Function in Heart FailureDie Wehrmacht in der RevolutionDie Wehrmacht in der RevolutionManagement of Chronic Congestive Heart Failure 1 March 1942Volume 16, Issue 3Page: 427-437KeywordsAtrial fibrillationCardiovascular therapyDrug therapyHeartHeart failureResearch funding ePublished: 1 December 2008 Issue Published: 1 March 1942 PDF downloadLoading ...

Digitalis in heart failure with normal rhythm: Gavey, C. J., and Parkinson, John: Brit. Heart J. 1: 27, 1939

Digitalis in heart failure with normal rhythm: Gavey, C. J., and Parkinson, John: Brit. Heart J. 1: 27, 1939