Digoxin in the management of cardiovascular disorders.

Case 1: A 45-year-old man in sinus rhythm, with an ejection fraction of 20%, normal coronaries, and normal renal function is receiving captopril 50 mg 3 times daily, carvedilol 25 mg and furosemide 40 mg twice daily, and spironolactone 25 mg daily. Despite these therapies, he continues to complain of dyspnea with minimal exertion. There are jugular venous distention, rales, and ankle edema. Oral digoxin, 0.125 mg daily, is added. After 3 weeks of maintenance therapy with digoxin, the patient feels better. Case 2: A 70-year asymptomatic woman in sinus rhythm, with coronary artery disease and ejection fraction of 35% is receiving once a day enalapril 10 mg, metoprolol succinate 200 mg, digoxin 0.125 mg, and furosemide 20 mg. There are no signs of heart failure. Six months after digoxin discontinuation she continues to remain asymptomatic.