The Effect of Digitalis on the Normal Human Electrocardiogram, with Especial Reference to A-v Conduction

Digitalis was given by mouth to five normal young male adults in amounts ranging from 2.0 to 3.0 gm. of standardized leaves in the course of 7 to 10 days. The As-Vs interval was prolonged in four of the five subjects, the greatest prolongation occurring in the case of the subject who received the most digitalis and none at all in one who received only 2.0 gm. There was no prolongation to so great an interval as 0.2 second until 2.7 gm. had been taken. The effects of the digitalis on conduction time began 5 to 6 days after the drug had been started and after 1.5 to 1.8 gm. had been taken. The effects persisted for 1 to 2 weeks after the drug had been stopped. Atropine removed completely the effect of digitalis on A-V conduction. The slowing heart rate after exercise was accompanied by an enhancement of the defect in conduction. The change in conduction through digitalis was therefore almost entirely, if not entirely, due to increase of vagal tone and irritability. Digitalis did not affect to an appreciable extent the Q-end of S and the Q-end of T intervals. Exercise and atropine both shortened the ventricular complex Q-end of T while the subject was under digitalis. The amplitude of the T wave, especially in Lead II, was changed within 48 hours after digitalis had been started, a decrease then beginning which became greater as the drug was continued and which persisted until 10 to 19 days after the digitalis had been stopped. The change in the T deflection preceded by several days the change in conduction time. The T wave, therefore, in the normal subject as well as in the patient gives us the earliest indication of digitalis action. The amplitudes of P, Q, R, and S were not materially influenced by the amounts of digitalis given. The pulse rate in two subjects became lower than usual at night as the result of the digitalis; otherwise there was no evidence of vagal action on the sino-auricular node. Blood pressure was uninfluenced by the digitalis. Mild subjective sensations occurred in all the subjects during the administration of the drug. A curious, hitherto undescribed, digitalis arrhythmia consisting of blocked auricular premature beats occurred in one subject after 3.0 gm. of digitalis had been taken.