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March 18, 1974

Intestinal Ischemia and Digitalis

Author Affiliations

Toronto East General Hospital Toronto

JAMA. 1974;227(11):1263. doi:10.1001/jama.1974.03230240021017

To the Editor.—  In his article, Recovery from Acute Intestinal Ischemia Without Bowel Resection (226:776, 1973), Dr. Vyden pointed out the importance of congestive heart failure in the pathogenesis of ischemic bowel disorder. He found the ischemic process to be reversible by appropriate treatment of the primary cause.In congestive failure, passive venous congestion to the splanchnic circulation and simultaneous increased sympathetic discharge result in vasoconstriction. The increase in sympathetic nervous outflow to the heart to increase rate is directly proportional to the increase in the sympathetic vasomotor outflow necessary to constrict visceral organs.1 Thus, the tachycardia in failure may be an index to the degree of vasoconstriction in the splanchnic bed. Digitalis, by ameliorating cardiac performance and output, tends to lessen passive venous congestion and also reduce vasoconstriction through diminished sympathetic outflow.Both cases presented by Vyden were treated with digitalis. In case 2, digoxin was given prior