[Digitalis and heart failure].

The authors first discuss the predominant cardiovascular mechanisms of the action of digitalis from a historical point of view. They then deal with different clinical situations in which the use of digitalis is limited, such as cardiac insufficiency resulting from altered diastolic function, although further studies dealing with the ratio of digitalis to diastolic function are necessary to gain a better insight into this problem. Finally, the discussion focuses on various clinical trials (including recent studies) on the use of digitalis in cardiac compensation in subjects with sinus rhythm. While the drug seems useless, if not risky in the majority of patients, in others with cardiomegaly, III tone and fluid overload the effects of the drug still seem beneficial at the clinical level. In this case, however, improved cardiac performance could not be demonstrated. The extra-inotropic types of digitalis action are thus reexamined, and some are correlated with favourable clinical effects which can be encountered in some forms of chronic heart failure.