The Old but Reliable Digitalis: Persistent Concerns and Expanded Indications

Abstract

SUMMARYDigitalis has been an old but reliable drug for 240 years. Concerns regarding its clinical indications and benefits still exist in the absence of a reduction in all‐cause mortality. While intravenous digitalis is used without question in cases of atrial fibrillation, it is still controversial in sinus rhythm, despite the Digitalis Investigation Group (DIG) study showing a significant reduction in death and the need for hospitalisation for congestive heart failure in both diastolic and systolic dysfunction. The influence of digitalis in acute myocardial infarction, coronary artery disease and sudden cardiac death remains speculative. In cases of uncomplicated hypertension, it appears to prevent the onset of left ventricular dysfunction and myocardial infarction. Thus, digitalis can be a cost‐effective agent with added benefits.

SGLT2 inhibitors improve cardiac function by improving intracellular calcium availability and optimizing the cell shape of cardiac myocytes

“…Blocking the sodium pump increases the cellular availability of sodium and calcium, aiding heart contractions. These drugs are used for congestive heart failure and heart arrhythmia, although their relative toxicity prevents widespread use (Abarquez Jr, 2001). They bind to the pumps and temporarily stop the ion traffic, allowing some potassium to leave the cell and some sodium to enter.…”