Indications for digitalis therapy: a new look

The indications for use of digitalis as an inotropic agent have been reexamined in the context of recent emphasis on the toxicity of digitalis and current knowledge regarding the mechanisms of clinical congestive heart failure in various disease states. Digitalis may be overprescribed in patients in whom the signs and symptoms of congestive heart failure are not due primarily to an impairment of myocardial contractility, administration of digitalis is not associated with notable improvement in cardiac function, or increases in contractility could have a deleterious effect on myocardial metabolism. There must be increased selectivity in the administration of digitalis to patients with heart disease and more emphasis on pharmacologic manipulation of other factors that control cardiac performance.