Digitalis Therapy in Cardiac Decompensation in Children

Abstract

Digitalis is often believed to be ineffectual in the treatment of cardiac disease in children. The most probable explanation for this belief is that the doses commonly used have been too small, for McCulloch and Rupe 1 have demonstrated that both normal children and those suffering from heart disease require from 10 to 100 per cent more digitalis per pound of body weight than do adults before electrocardiographic or other signs of digitalization are produced. Our studies of twenty-six children suffering from severe myocardial failure confirm this report, and lead us to the conclusion that even larger doses are beneficial in causing a loss of edema and an increase in the patient's comfort. Digitalis will not, of course, repair the myocardial damage, but a comparison between the fate of children treated with the drug and that of those who did not receive it would seem to indicate that the administration of digitalis will to some extent prolong life by providing an opportunity for compensation. MATERIAL These twenty-six patients (table 1) suffered from rheumatic endocarditis and myocarditis, and represent all the cases of severe cardiac decompensation admitted to this hospital from 1921 to 1926. All were orthopneic and edematous, and half of them (thirteen) had marked ascites. None of the cases of rheumatic endocarditis in which the symptoms of decompensation were absent or slight were included. These children were from 3 to 13 years of age, and had had their first attack of acute rheumatic fever or chorea from three months to five years previously. Of these twenty-six patients, twenty-one had had rheumatic fever, in some instances chorea also, and the remaining five had had chorea alone. Symptoms and signs of heart disease had been present from three to thirty months before decompensation developed.

A study of the standardization of digitalis. I. A method for clinical standardization

“…The number of its functions which influence the effect of digitalis must be great. It has been shown that age is important, for young children require up to two or two and a half times the body-weight dose for adults (5). The Eggleston method (3) of giving the drug has been found very useful, and has done much to clarify the problems of the clinical use of digitalis.…”