A. Digitalis (Digoxin)
In 1775, William Withering, a Birmingham physician, learned of a midwife whose herbal brew had cured several people suffering from severe swelling of the legs and shortness of breath. The condition at that time was called dropsy. Withering studied the brew and concluded that the only active constituent of the 20 or more herbs was derived from the foxglove plant (Digitalis purpurea). He used the herb with a fair amount of success.
Digitalis has since been used extensively across the world to treat millions of people with heart failure. It causes the heart muscle to contract more forcefully which increases the flow of blood to the kidneys. Congestion, shortness of breath, and edema improve. This drug also slows the heart rate and causes the heart muscle to use oxygen more efficiently. In some individuals, heart failure is precipitated by a very irregular heart rhythm called atrial fibrillation,

TABLE 1
Echocardiography, the Most Useful Test to Evaluate Patients
with Proven Heart Failiure
1. Assess left ventricular (LV) function, provides a sufficiently accurate ejection fraction (EF)a for guidance of therapy
2. Screen for regional or global hypokinesis
3. Gives accurate cardiac dimensions; replaces radiology for cardiac chamber dilation

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