The Use of Digitalis in Mitral Stenosis without Right Heart Failure.

I NDICATION FOR DIGITALIZATION of patients with cardiovascular disease has long been the presence of manifest heart failure or some specific arrhythmias, atrial flutter, atrial fibrillation and sometimes other atrial tachycardias. The presence of heart disease as such has not been thought to be sufficient indication to start a patient on digitalis therapy, mostly for two reasons. First, because there has not been any data indicating any beneficial effect of digitalis in a patient not in heart failure and, second, because of a fear that digitalization might have a negative effect in these patients. Some studies showing diminished cardiac output after digitalization in subjects without heart disease are often quoted in this connection.l~ 26 The difficulty in reaching an adequate dose of digitalis in a patient without symptoms of heart failure or arrhythmias has certainly added to the reluctant feelings most physicians have towards the use of digitalis in such patients. There was a time when digitalis was thought to be of value only in those cases of heart failure when atrial fibrillation was also present. It has later been shown quite convincingly both in hemodynamic 22,25,~3 and clinical studies 14 that digitalis improves the circulation and clinical condition of patients in cardiac failure regardless of the prevailing rhythm. Agreed policy even of world famous cardiologists may thus not necessarily be right. It may be proper to review now the data available regarding the effect of digitalis in patients nor in heart failure in order to see whether the routine of reserving digitalis only to patients in heart failure is really founded on sound principles. This is especially timely as many recent studies have been concerned with the effect of digitalization on the nonfailing heart, l9,12,13,15-el,28,24,27,2s,3~