THE statement that lanatoside is replacing homicide as a leading cause of death in the United States is greatly exaggerated. However, approximately 20% of hospitalized patients receiving digitalis preparations manifest some evidence of toxicity. The frequency of adverse reactions can and should be reduced without depriving patients of the benefits of digitalis. This drug remains the key to effective therapy for heart failure. Old concepts of "digitalization" have contributed to frequent digitalis toxicity. New knowledge of the pharmacology of digitalis, the development of more effective diuretic agents, and clearer insight into the physiology of myocardial failure allow safer and more effective treatment. This information will enable physicians to become more comfortable and confident in the use of these agents.
The major effect of digitalis is to increase the strength and velocity of myocardial contraction.1 This is accomplished by making more calcium available to the contractile proteins. Increased contractility is
Walker WJ. Treatment of Heart Failure. JAMA. 1974;228(10):1276–1278. doi:10.1001/jama.1974.03230350048034
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