Hemodynamic response to acute intravenous digoxin in patients with recent myocardial infarction and coronary insufficiency with and without heart failure

Intravenous digoxin was administered to 12 patients, 10 with acute myocardial infarction and two with acute coronary insufficiency. 6 patients had clinical failure and 6 did not. There was no beneficial hemodynamic response in the group without heart failure and only slight response in the group with mild to moderate heart failure. No significant rise in cardiac index or fall in pulmonary artery end diastolic pressure occurred in either group. Maintenance digoxin therapy did not prevent the development of heart failure in 2 patients. A significant incidence of ventricular dysrhythmias occurred. The limited hemodynamic response in patients with heart failure may be due to the systemic vascular effects of digoxin, high levels of circulating catecholamines, and altered properties of the acutely ischemic or infarcted myocardium. The prophylactic use of digitalis glycosides in uncomplicated myocardial infarction cannot be advocated. Modifications are suggested in the indications for, and dose regimens of cardiac glycosides in heart failure complicating myocardial infarction.