Evidence supporting the use of: Glycoside
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Glycosides, specifically cardiac glycosides such as digoxin and digitoxin derived from the foxglove plant (Digitalis species), have a long-standing, scientifically validated role in the management of congestive heart failure (CHF). Their use dates back to the 18th century, when William Withering first documented the therapeutic effects of digitalis in treating "dropsy," now known as heart failure. The primary mechanism of action is inhibition of the sodium-potassium ATPase pump in cardiac myocytes, which leads to increased intracellular calcium concentrations, thereby enhancing cardiac contractility (positive inotropy). This improvement in contractility helps the failing heart pump more efficiently, providing symptomatic relief in patients with CHF, particularly those with reduced ejection fraction and concurrent atrial fibrillation. Multiple clinical trials and meta-analyses support the efficacy of digoxin in reducing symptoms and hospitalizations in CHF, though its effect on mortality is neutral. Its narrow therapeutic window and potential for toxicity have led to more restricted use, especially since the advent of safer, more effective medications (e.g., ACE inhibitors, beta-blockers), but it remains a valuable option in select patients, particularly for rate control in atrial fibrillation with heart failure. Overall, the use of cardiac glycosides in CHF is both historically and scientifically validated, though modern guidelines recommend careful patient selection and monitoring.

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