Digoxin: INCREASE or DECREASE O2 demand?

[Ven0m]

conrad fischer in 2010 kaplan videos states to never use digoxin in CHF because it increases myocardial o2 demand (accelerating the disease), however, everywhere else on the web, it says digoxin either has no effect on o2 demand or even decreases o2 demand hence its widely used in heart failure.

so as of 2017, is digoxin used for HF? or do we use RAAS inhibitors like fischer says to?

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[ASM student]

In my cardiology rotation they told us that it's used mainly as antiarrhythmic in HF as most of the other antiarrhythmic drugs have -ve inotropic effect which will exacerbate the congestive state of the patient, but it's not used routinly with HF.

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[cellsaver]

conrad fischer in 2010 kaplan videos states to never use digoxin in CHF because it increases myocardial o2 demand (accelerating the disease), however, everywhere else on the web, it says digoxin either has no effect on o2 demand or even decreases o2 demand hence its widely used in heart failure.

so as of 2017, is digoxin used for HF? or do we use RAAS inhibitors like fischer says to?

digoxin was once the first line drug for HF for many years. Dr Conrad Fischer is speaking to an audience that was aware of how digoxin was viewed during their time...7 years ago. Physicians are creatures of habit. Once they adopt a treatment paradigm, it is hard to change. Dr Fischer was driving home the point a new paradigm to an uninitiated audience: "do not use Dig for HF as first line like older physicians do." (paraphrase)

Dig is indicated for Afib and Mild to Moderate HF and where possible with a diuretic or ACEI
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020405s006lbl.pdf

It improves symptoms and decreases hospital stay, but it does not improve overall survival, unlike Beta Blockers

Beta Blockers cause negative inotropy hence decrease O2 demand
Dig causes positive inotropy hence demands more O2
Frank Starling Law applies here.

Katzung Pharmacology has all of this information.
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Conrad is funny and entertaining but all of the Kaplan videos are obsolete and are not comprehensive. Consult your school's list of required textbooks. Then you can write the Kaplan instructors and tell them how their videos were fun...and sometimes wrong. e.g. Microbiology professor Dr Kim Moscatello

 

[Ven0m]

Thanks mate! 8)