The Effect of Digitalis on the Cardiac Output of the Normal Heart at Rest and during Exercise
Authors: THEODORE RODMAN
Journal: Annals of Internal Medicine (1961)

Article1 October 1961The Effect of Digitalis on the Cardiac Output of the Normal Heart at Rest and during ExerciseTHEODORE RODMAN, M.D., CASIMIR A. GORCZYCA, M.D., BERNARD H. PASTOR, M.D., F.A.C.P.THEODORE RODMAN, M.D., CASIMIR A. GORCZYCA, M.D., BERNARD H. PASTOR, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-4-620 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThere is a prevalent feeling among physicians that digitalis is toxic to the compensated heart. As a result clinicians have frequently been reluctant to administer this drug except in the presence of overt congestive heart failure or certain atrial arrhythmias. Most textbooks of pharmacology and cardiology state that digitalis reduces the cardiac output of both the normal and the enlarged nonfailing heart (1-9) by as much as 20 to 35% (4). Examination of the literature on which this idea is based reveals that the studies were frequently done under unphysiological conditions on heart-lung preparations (10) or in animals (11-13). Some...References1. GOODMANGILMAN LSA: The Pharmacological Basis of Therapeutics, 2d Ed., The Macmillan Co., New York, 1955, p. 678. Google Scholar2. BECKMAN H: Treatment in General Practice, 6th Ed., W. B. Saunders Co., Philadelphia, 1948, p. 738. Google Scholar3. BECKMAN H: Pharmacology in Clinical Practice, W. B. Saunders Co., Philadelphia, 1952, p. 154. Google Scholar4. GROLLMAN A: Pharmacology and Therapeutics, 2d Ed., Lea & Febiger, Philadelphia, 1954, p. 341. Google Scholar5. KRANTZCARR JCCJ: The Pharmacologic Principles of Medical Practice, 2d Ed., The Williams & Wilkins Co., Baltimore, 1951, p. 793. Google Scholar6. FRIEDBERG CK: Disease of the Heart, 2d Ed., W. B. Saunders Co., Philadelphia, 1956, p. 250. Google Scholar7. LEVINE SA: Clinical Heart Disease, 5th Ed., W. B. Saunders Co., Philadelphia, 1958, p. 361. Google Scholar8. RUSKIN A: Physiological Cardiology, Charles C Thomas, Springfield, Ill., 1953, p. 111. Google Scholar9. GROSSJEZER HA: Treatment of Heart Disease, W. B. Saunders Co., Philadelphia, 1956, p. 34. Google Scholar10. COHNSTEELE AEJM: Studies on the effect of the action of digitalis on the output of blood from the heart. 1. The effect on the output of the dog's heart in heart-lung preparations. J. Clin. Invest. 11: 871, 1932. CrossrefMedlineGoogle Scholar11. COHNSTEWART AEHJ: The relation between cardiac size and cardiac output per minute following the administration of digitalis in normal dogs. J. Clin. Invest. 6: 53, 1928. CrossrefMedlineGoogle Scholar12. COHNSTEWART AEHJ: The relation between cardiac size and cardiac output per minute following administration of digitalis in dogs in which heart is enlarged. J. Clin. Invest. 6: 79, 1928. CrossrefMedlineGoogle Scholar13. HARRISONLEONARD TRBW: The effect of digitalis on the cardiac output of dogs and its bearing on the action of the drug in heart disease. J. Clin. Invest. 3: 1, 1926. CrossrefMedlineGoogle Scholar14. STEWARTCOHN HJAE: Studies on effect of digitalis on output of blood from heart; effect on output in normal human hearts; effect on output of hearts in heart failure with congestion, in human beings. J. Clin. Invest. 11: 917, 1932. CrossrefMedlineGoogle Scholar15. STEWARTCRANEDEITRICHTHOMPSON HJNFJEWP: Action of digitalis in compensated heart disease. Arch. Intern. Med. 62: 547, 1938. CrossrefGoogle Scholar16. BURWELLNEIGHBORSREGEN CSDWEM: The effect of digitalis upon the output of the heart in normal man. J. Clin. Invest. 5: 125, 1927. CrossrefMedlineGoogle Scholar17. EDDLEMANWILLISGREVEHEYER EEKMJHE: The effect of digitoxin on the apparent stroke volume, posteroanterior cardiac diameter, and the cardiac cycle in normal subjects as studied by the electrokymograph. Amer. Heart J. 41: 161, 1951. CrossrefMedlineGoogle Scholar18. ERICKSONFAHR EWGE: The effect of lanatoside C upon the physiologic state of organically diseased hearts before symptoms and signs of heart failure appear. Amer. Heart J. 29: 348, 1945. CrossrefGoogle Scholar19. SELZERHULTGRENEBNOTHERBRADLEYSTONE AHNCLHWAO: Effect of digoxin on the circulation in normal man. Brit. Heart J. 21: 335, 1959. CrossrefMedlineGoogle Scholar20. DRESDALEYUCEOGLUMICHTOMSCHULTZLUNGER DTYZRJMM: Effects of lanatoside C on cardiovascular hemodynamics; acute digitalizing doses in subjects with normal hearts and with heart disease without failure. Amer. J. Cardiol. 4: 88, 1959. CrossrefMedlineGoogle Scholar21. GOODYEARCHETRICKHUVOS AVAA: The effect of lanatoside C on the response of the human cardiac output to walking exercise. Yale J. Biol. Med. 32: 265, 1960. MedlineGoogle Scholar22. COTTENSTOPP MDPE: Action of digitalis on the nonfailing heart of the dog. Amer. J. Physiol. 192: 114, 1958. CrossrefMedlineGoogle Scholar23. BLOODWELLGOLDBERGBRAUNWALDGILBERTROSSMORROW RDLIEJWJAG: Myocardial contractility in man: the acute effects of digitalis, sympathomimetic amines, and anoxic cardiac arrest. Surg. Forum 10: 532, 1960. MedlineGoogle Scholar24. BRAUNWALDBLOODWELLGOLDBERGMORROW ERDLIAG: Studies on digitalis. IV. Observations in man on effects of digitalis preparations on the contractility of the nonfailing heart and on total vascular resistance. J. Clin. Invest. 40: 52, 1961. CrossrefMedlineGoogle Scholar25. MODELL W: Clinical pharmacology of digitalis materials. Clin. Pharmacol. Ther. 2: 177, 1961. CrossrefMedlineGoogle Scholar26. CATTELLGOLD MH: Influence of digitalis glucosides on force of contraction of mammalian cardiac muscle. J. Pharmacol. Exp. Ther. 62: 116, 1938. Google Scholar27. GOLDCATTELL HM: Mechanism of digitalis action in abolishing heart failure. Arch. Intern. Med. 65: 263, 1940. CrossrefGoogle Scholar28. STEADWARRENBRANNON EAJVES: Effect of lanatoside C on the circulation of patients with congestive failure; study using catheterization of right side of heart. Arch. Intern. Med. 81: 282, 1948. CrossrefGoogle Scholar29. AHMEDBAYLISSBRISCOEMCMICHAEL SRIWAJ: The action of ouabain (g-strophanthin) on circulation in man and comparison with digoxin. Clin. Sci. 9: 1, 1950. Google Scholar30. FERRERHARVEYCATHCARTWEBSTERRICHARDSCOURNAND MIRMRTCADWA: Some effects of digoxin upon the heart and circulation in man. Circulation 1: 161, 1950. CrossrefMedlineGoogle Scholar31. MCMICHAELSHARPEY-SCHAFER JEP: Action of intravenous digoxin in man. Quart. J. Med. 13: 123, 1944. Google Scholar32. TAINTERDOCK MLW: Further observations on the circulatory action of digitalis and strophanthus with special reference to the liver, and comparisons with histamine epinephrine. J. Clin. Invest. 8: 485, 1930. CrossrefMedlineGoogle Scholar33. DOCKTAINTER WML: The circulatory changes after full therapeutic doses of digitalis, with a critical discussion of views of cardiac output. J. Clin. Invest. 8: 467, 1930. CrossrefMedlineGoogle Scholar34. KATZRODBARDFRIENDROTTERS-MAN LNSMW: The effect of digitalis on the anesthetized dog; action on splanchnic bed. J. Pharmacol. Exp. Ther. 62: 1, 1938. Google Scholar35. HORSLEYECKSTEIN AWJW: The effect of acetyl strophanthidin on peripheral venous tone in man. (Abstract) J. Lab. Clin. Med. 54: 827, 1959. Google Scholar36. RossBRAUNWALDWALDHAUSEN JEJA: Studies on digitalis. II. Extracardiac effects on venous return and on the capacity of the peripheral vascular bed. J. Clin. Invest. 39: 937, 1960. CrossrefMedlineGoogle Scholar37. BASCHIERIRICCIMAZZUOLIVASSALLE LPDGFM: Studi su la portata epatica nell'uomo; modificazioni del flusso epatico da digitale. Cuore Circol. 41: 103, 1957. MedlineGoogle Scholar38. WILLIAMSZOHMANRATNER MHLRAC: Hemodynamic effects of cardiac glycosides in normal human subjects during rest and exercise. J. Appl. Physiol. 13: 417, 1958. CrossrefMedlineGoogle Scholar39. COOPERWILLMANZAFIRACOPOULOUSHANLON TVLPCR: Effect of prophylactic digitalization on myocardial function after elective cardiac arrest. Ann. Surg. 151: 17, 1960. MedlineGoogle Scholar40. WILLMANCOOPERHANLON LVTCR: Prophylactic and therapeutic use of digitalis in open heart operations. Arch. Surg. 80: 860, 1960. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, PennsylvaniaReceived for publication June 5, 1961.From the Cardiopulmonary Division of the Medical Research Laboratory, Veterans Administration Hospital, Philadelphia, Pa.Presented at the Forty-second Annual Session of The American College of Physicians, Miami Beach, Florida, May 8-12, 1961.Requests for reprints should be addressed to Theodore Rodman, M.D., Staff Physician, Pulmonary Function Laboratory, Veterans Administration Hospital, University and Woodland Avenues, Philadelphia 4, Pa. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByThe Short-term Effects of Digoxin in Patients With Right Ventricular Dysfunction From Pulmonary HypertensionAcute hemodynamic effects of digoxin alone or in combination with other vasoactive agents in patients with congestive heart failureAssessment of the hemodynamic response to acetyl-strophanthidin by Doppler echocardiography in normal subjects and in those with coronary artery disease or idiopathic dilated cardiomyopathyComparative hemodynamic and neurohormonal effects of intravenous captopril and digoxin and their combinations in patients with severe heart failureDigitalis Therapy for Congestive Heart Failure: Is the Jury Still Out?Hepatocellular carcinoma diagnostic and prognostic features in north american patientsTherapie der akuten und chronischen Herzinsuffizienz mit HerzglykosidenPharmacodynamic effects of ouabain following single sublingual and intravenous doses in normal subjectsPharmakodynamikThe interrelationship of factors controlling cardiac outputThe Effect of Digoxin on Exercise Capacity and Exercising Cardiac Function in Cystic FibrosisEffects of Cardiac Glycosides on Vascular SystemEffects of rapid digitalization on total and regional myocardial performance in patients with coronary artery diseaseEffect of digitalis on left ventricular function in exercising dogs.Short- and long-term effects of digitalis on resting and posthandgrip hemodynamics in patients with coronary artery diseaseFavorable effects of oral maintenance digoxin therapy on left ventricular performance in normal subjects: Echocardiographic studyHemodynamic response to digitalization in patients with hypertensive cardiovascular diseaseCardiac GlycosidesVariability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery diseaseDigitalisDas Verhalten des Herzrhythmus während genereller Anaesthesie unter besonderer Berücksichtigung von DigitalisDer Kreislauf des Hochleistungssportlers in Ruhe und BelastungIII. PodiumsgesprächDigitalis in non-failing cardiac diseasesNewer Concepts Regarding Digitalis TherapyNew developments in the understanding of the actions of the digitalis glycosidesThe Scientific Basis for the Use of Drugs in Cardiovascular DiseasePrevention of heart failureStudies on DigitalisHAEMODYNAMICS IN ACUTE PULMONARY OEDEMA IN CORONARY PATIENTSPharmacodynamic studies in aortic regurgitationEffect on cardiac output of conversion from atrial fibrillation to normal sinus mechanismNewer concepts of digitalisMedical Aspects of Open-Heart SurgeryInfluence of Digitalization on the Contribution of Atrial Systole to the Cardiac Dynamics at a Fixed Ventricular RateEarly effects of digitalis on central hemodynamics in normal subjectsThe use of digitalis in cardiovascular surgeryAction of digitalis upon the nonfailing heart: A critical reviewThe use of digitalis in mitral stenosis without right heart failureThe effect of digoxin in normal man on the cardiorespiratory response to severe effortThe hemodynamic effects of digitalis in the normal and diseased heartCardiac Glycosides 1 October 1961Volume 55, Issue 4Page: 620-631KeywordsCardiac outputDrugsEmotionsExerciseHeartHeart failureLongitudinal studiesPharmacologyResearch laboratoriesStatistical data Issue Published: 1 October 1961 PDF DownloadLoading ...