The value of digitalization and diuretics for the control of exertional dyspnea in patients with established chronic heart disease was studied in a group of 93 ambulant patients without auricular fibrillation. They were selected from a total of 204 patients with the diagnosis of congestive heart failure, in terms of the conventional criteria, on the basis that exertional dyspnea was the presenting problem, that physical signs of congestion were equivocal or absent, and that they were free of manifest complicating factors that might cause dyspnea. About three-fourths of them were in the older age groups with arteriosclerotic and/or hypertensive heart disease. In this type of patient long-term treatment with digitoxin failed to enhance the capacity for exertion without shortness of breath while the diuretic (meralluride sodium) afforded relief in many. A therapeutic test was suggested to detect those in whom prolonged treatment with diuretics should be pursued, also a similar test to detect the large numbers of patients who are commonly subjected to long and intensive treatment with digitalis materials, with high potentiality for toxic actions, but in whom there is little prospect of beneficial results.
Gold H, Greiner T, Kwit NT, Otto HL, Warshaw L. EFFECT OF DIGITALIS AND DIURETICS ON EXERTIONAL DYSPNEA: STUDY IN AMBULANT PATIENTS WITH CHRONIC HEART DISEASE. JAMA. 1959;169(3):229–236. doi:10.1001/jama.1959.03000200027006
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