[The place of cardiac glycosides in the treatment of chronic heart failure. Part II. Results of small studies].

In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Part II is devoted to analysis of results of small controlled studies of pharmacological effects of low dose digoxin in patients with sinus rhythm. Low dose digoxin improves exercise tolerance and lowers risk of decompensation of heart failure but produces no substantial effect on contractility of left ventricular myocardium. Therefore its favorable action on clinical course and outcomes of chronic heart failure is most probably related to modulation of neuro-humoral systems. Retrospective analysis of some trials shows that digoxin is able to increase mortality of survivors of acute myocardial infarction. Hence great care is required when digoxin is used for long term treatment of chronic heart failure due to systolic left ventricular dysfunction after myocardial infarction.