Digoxin
                                =======

þ Digoxin effects
 - positive inotropic
 - negative chronotropic
 - for atrial fibrillation
  + now found to do very little to prevent recurrences of a fib nor to control
    rate with paroxysms of a fib
  + decreases rate in atrial fibrillation by increasing vagal tone; this
    disappears during exercise, however, so digoxin's rate control disappears
    during exercise, unlike with beta blockers or calcium channel blockers,
    which are better choices for active people.
 [Falk RH, Leavitt JI. Digoxin for atrial fibrillation: a drug whose time has
 gone? Ann Intern Med 1991;114:573.]

þ Verapamil + Quinidine are better than Digoxin + Quinidine
 - [Innes GD, Vertesi L, Dillon EC, Metcalfe C. Effectiveness of
   verapamil-quinidine versus digoxin-quinidine in the emergency department
   treatment of paroxysmal atrial fibrillation Ann Emerg Med 1997; 29:126-34.]
   Abstract: <DCA.TXT -Innes>
 - Innes gave stable patients:
  + 5 mg Verapamil over 2-3 minutes at 0, 20, 60 and 120 minutes, stopping
    when rate was less than 100; then,
  + Quinidine Sulfate 200 mg PO Q2H unitl (1)conversion, (2) got to 1 g of
    quinidine, (3) adverse effects, or (4) patient deteriorates

þ Diltiazem works a lot faster than Digoxin
 - [Schreck DM, Rivera AR, Tricarico VJ. Emergency management of atrial
   fibrillation and flutter: intravenous diltiazem versus intravenous digoxin.
   Ann Emerg Med 1997; 29:135-40.]
   Abstract: <DCA.TXT -Schreck>