Digitalis and Diuretics in Heart Failure With Regular Rhythm, With Especial Reference to the Importance of Etiologic Classification of Heart Disease

There is probably complete agreement today that digitalis affects the signs and symptoms ot congestive heart failure most satisfactorily in the presence of auricular fibrillation.There is widespread agreement among American clinicians and investigators that a certain number of patients with heart failure and normal sinus rhythm respond to the administration of digitalis almost as satisfactorily as do those with auricular fibrillation, and many believe that such patients belong chiefly to the group designated as "chronic myocarditis" or "myocardial insufficiency."While this view has been expressed by many excellent observers, it remained for Luten (1) to bring forward the most convincing evidence in its support by a careful study which was the first to provide adequate control observations.That there are several factors which influence the response of the regular heart to digitalis has long been recognized.More than a decade ago, Cohn (2) pointed out that rhythm alone was not a sufficient basis for the division of patients if the effect of digitalis was to be studied, and emphasized that the presence or absence of hypertension and the presence or absence of edema had to be considered.The value of a division into the groups which he suggested has been amply demonstrated by later work.Christian (3), Windle (4), Eggleston (5) and others have called attention to the importance of the stage of heart failure, stating that even when favorable results from digitalis are obtained at one time, the response to treatment becomes less satisfactory with each succeeding episode of failure.5i2