Affiliation:
1. From the Department of Medicine, Division of Cardiology (P.J.H.), Saint Louis University School of Medicine, St. Louis, MO; and the Cardiovascular Division (R.A.K.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.
Abstract
Abstract
—Cardiac glycosides have played a prominent role in the therapy of congestive heart failure since William Withering codified their use in his late 18th century monograph on the efficacy of the leaves of the common foxglove plant (
Digitalis purpurea
). Despite their widespread acceptance into medical practice in the ensuing 200 years, both the efficacy and the safety of this class of drugs continue to be a topic of debate. Moreover, despite the fact that the molecular target for the cardiac glycosides, the α-subunit of sarcolemmal Na
+
K
+
-ATPase (or sodium pump) found on most eukaryotic cell membranes, has been known for several decades, it remains controversial whether the sympatholytic or positive inotropic effects of these agents is the mechanism most relevant to relief of heart failure symptoms in humans with systolic ventricular dysfunction. Herein, we review the molecular and clinical pharmacology of this venerable class of drugs, as well as the manifestations of digitalis toxicity and their treatment. We also review in some detail recent clinical trials designed to examine the efficacy of these drugs in heart failure, with a focus on the Digoxin Investigation Group data set. Although, in our opinion, the data on balance warrant the continued use of these drugs for the treatment of symptoms of heart failure in patients already receiving contemporary multidrug therapy for this disease, the use of digitalis preparations will inevitably decline with the maturation of newer pharmacotherapies.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Reference30 articles.
1. Withering W. An account of the foxglove and some of its medical uses with practical remarks on dropsy and other diseases. In: Willius FA Keys TE eds. Classics of Cardiology . New York NY: Dover Publications Inc; 1941;1:231–252.
2. Eisner DA Smith TW. The Na-K pump and its effectors in cardiac muscle. In: Fozzard HA Haber E Katz AM Morgan HE eds. The Heart and Cardiovascular System . New York NY: Raven Press; 1991:863–902.
3. Kelly RA Smith TW. Pharmacological treatment of heart failure. In: Goodman & Gilman’s The Pharmacological Basis of Therapeutics . 9th ed. New York NY: McGraw-Hill; 1996:809–838.
4. Skou JC. The Na K-pump. In. Fleischer S Fleischer B eds. Methods in Enzymology . San Diego Calif: Academic Press; 1988;156:1–28.
5. Na,K-ATPase
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