An evaluation of digitalis tolerance with acetyl strophanthidin.

The determination of the state of digitalization in a given patient is often difficult and at times impossible. Although Eggleston1 indicated that the required quantity of digitalis is a function of body weight, the digitalizing dose is an empiric and occasionally a dangerous assumption. Clinically, the classical symptoms of digitalis intoxication may mimic those of circulatory failure. Nausea, vomiting, and abdominal distress may be secondary to hepatic and visceral congestion; premature ventricular systoles may be a manifestation of myocardial anoxia; and paroxysmal tachycardia may indicate excessive or inadequate digitalis administration. The electrocardiogram indicates digitalis effect, but no quantitative correlation with the S-T segment and T wave changes exists. Only with the electrocardiographic appearance of auriculoventricular block, premature ventricular systoles, bigeminus rhythm, nodal rhythm, etc., is toxicity apparent.