Digitalis in patients after myocardial infarction.

For more than two centuries digitalis has been used in the treatment of cardiac disease. Despite this long clinical experience with the drug, controversy still exists as to its clinical effect and impact on survival, especially in patients after myocardial infarction. In the last decade a number of studies have addressed the problem of assessing the clinical effect of digitalis in patients with sinus rhythm and left ventricular dysfunction. An overall conclusion from these studies seems to indicate that a modest clinical beneficial effect can be expected from the drug. Regarding the effect of digitalis on the mortality in patients after a myocardial infarction controversy still prevails. All studies show an increased mortality in patients using digitalis, but opinions differ as to whether this is due solely to baseline imbalances between the populations or that a harmful effect of digitalis itself exists as well. This question cannot be answered with certainty until the results from a large, randomized study are available. In the meantime digitalis can probably be used as a first line therapy in patients with atrial fibrillation and left ventricular dysfunction. In patients with sinus rhythm and heart failure, however, it is probably wise to reserve digitalis to those that are still symptomatic after diuretics, nitrates and ACE inhibitors have been tried.