4. Assess regional LV wall motion abnormalities that indicate ischemia and significant coronary heart disease
5. Assess hypertrophy: concentric or other
6. Left atrial enlargement common with valvular heart disease and an early sign of left ventricular hypertrophy
7. Assess valvular heart disease
8. Congenital heart disease
9. Diastolic dysfunction, assess after known normal systolic function and no valvular disease

10. Pericardial disease, effusion, tamponade
11. Myocardial disease
12. Left atrial myxoma
aNuclear imaging is more accurate for EF in absence of atrial fibrillation but does not assess valves, hypertrophy, or items 3 to 11, cost of two tests not justifiable.
From Khan, M. Gabriel (2003). Cardiac Drug Therapy, sixth edition, Philadelphia; W. B. Saunders, p. 260.
and heart rate may increase to 120–200 beats per minute. In such patients, digitalis is very successful in reducing the heart rate to 60–90 beats per minute and causes complete clearing of heart failure. Digitalis remains the only avail¬able oral drug to treat heart failure caused by atrial fibril¬lation, and today this is its main indication.
Digitalis is not used in all cases of heart failure where the heart rhythm is normal, because in some of these, a diuretic and an ACE inhibitor bring relief. Digitalis is available under various names. The most known and generally used preparation is digoxin. Digoxin is the purest preparation of digitalis and gives reliable blood levels. Thus, we will confine most of the remarks to this pre¬paration. Other preparations have very minor differences in absorption from the gut, blood levels, and duration of action. Digoxin is marketed under different brand names and Lanoxin is the most common. Supplied: Tablets: 0.125 mg, 0.25 mg. Dosage: For maintenance, 0.25 mg daily usually at bedtime. In patients over age 70, 0.125 mg daily is usually sufficient. A lower dose of digoxin is now used compared with the dose advised in the previous 50 years. A serum digoxin level 0.5–0.8 ng/ml is adequate for beneficial effects in the management of heart failure. Patients on a low dose with the serum level indicated above have been shown to be less likely to experience worsening heart failure and both their ejection fractions and tread¬mill exercise times were significantly higher than patients taking higher doses.

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