CASE – 10

A 69-year-old man sees you in the office for follow-up of his chronic conges- tive heart failure. He has a marked reduction in his ejection fraction following a series of MIs. He also has hypertension and type II diabetes mellitus. His symptoms include dyspnea on exertion, orthopnea, paroxysmal nocturnal dys- pnea, and peripheral edema. He has normal renal function. He is on appropriate treatment of his diabetes, along with an ACE inhibitor and a loop diuretic. You decide to add digoxin to his regimen.

1) What is the effect of digoxin on the normal heart?

2) What is the effect of digoxin on the failing heart?

3) What neural effects does digoxin have?

4) What are the side effects and toxicities of digoxin?

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