DIGITALIS IN PATIENTS AFTER MYOCARDIAL-INFARCTION

For more than two centuries digitalis has been used in the treatment o f cardiac disease. Despite this long clinical experience with the drug , controversy still exists as to its clinical effect and impact on sur vival, especially in patients after myocardial infarction. In the last decade a number of studies have addressed the problem of assessing th e clinical effect of digitalis in patients with sinus rhythm and left ventricular dysfunction. An overall conclusion from these studies seem s 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 imbalance s 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 mean time digitalis can probably be used as a first line therapy in patient s with atrial fibrillation and left ventricular dysfunction. In patien ts with sinus rhythm and heart failure, however, it is probably wise t o reserve digitalis to those that are still symptomatic after diuretic s, nitrates and ACE inhibitors have been tried.