A 42-year-old man was admitted to the hospital in acute distress with breathlessness,
markedly distended neck veins and atrial fibrillation. The blood pressure was 100/90 mm
Hg, the pulse 120 BPM. An echocardiogram revealed an ejection fraction of 35%. A
treatment was started with furosemide, captopril and digoxin. In this patient digoxin most
likely decreased which of the following cardiovascular parameters?
A. Stroke volume B. End-systolic volume C. End diastolic volume D. Systolic pressure E. Pulse pressure
End-systolic volume-learning objective: describe the hemodynamic actions of cardiac glycosides in the failingheart.answer: ban inotropic drug increases the force of heart contraction and therefore a higher fraction of theend-diastolic volume is ejected during systole. as a consequence the end systolic volume (that isthe volume of blood remaining in the ventricle at the end of the systole) is decrease.a) all inotropic drugs increase, not decrease, the stroke volume.c) the end-diastolic volume (that is the volume of blood filling the ventricles at the end of thediastole) is the sum of the end systolic volume plus the stroke volume. since the stroke volumeis increased, and the end systolic volume is decreased by inotropic drugs, the end diastolicvolume is not significantly changed.d) digoxin increases, not decreases, the systolic blood pressure in patient with cardiac failurebecause of the increase in cardiac output.e)pulse pressure may be sharply decreased in patients with heart failure since systolic pressurecannot be maintained because of the decrease in cardiac output, whereas diastolic pressure isnormal or increased because of sympathetic activation. by increasing cardiac output digoxinincreases the systolic pressure and offsets the reactive, sympathetically-mediatedvasoconstriction. therefore the pulse pressure is increased, not decreased.