Editing Digoxin (section)

=== Heart failure ===
[[Digitalis]] (i.e. extracts, including digoxin, from the plant genus ''Digitalis'') was the first drug used to treat [[dropsy]] (swollen ankles—a symptom of heart failure) following its discovery by [[William Withering]].<ref>{{cite book | vauthors = Withering W | url = https://archive.org/details/b21517356 | title = An Account of the Foxglove and some of its Medical Uses | location = Birmingham, England | publisher = M. Swinney | date =  1785 }}</ref> Alongside [[diuretics]], it was the mainstay of treatment for heart failure for over a century. Since the introduction of other drugs with better outcomes and fewer adverse effects, it is generally now only used where heart failure is associated with atrial fibrillation and or a rapid ventricular rate.<ref name="ESC2021">{{cite journal | vauthors = McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Kathrine Skibelund A | display-authors = 6 | title = 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure | journal = European Heart Journal | volume = 42 | issue = 36 | pages = 3599–3726 | date = September 2021 | pmid = 34447992 | doi = 10.1093/eurheartj/ehab368 | publisher = European Society of Cardiology | doi-access = free }}</ref> In certain circumstances it may be used under specialist guidance in addition to, or instead of, the recommended first-line treatments of  [[ACE inhibitor]], [[beta blocker]], [[Antimineralocorticoid|mineralocorticoid antagonist]], and [[SGLT-2 inhibitor]], where they are not effective or not tolerated. <ref>{{cite journal | vauthors = Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG, Koshman SL, Lepage S, McKelvie RS, Moe GW, Rajda M, Swiggum E, Virani SA, Zieroth S, Al-Hesayen A, Cohen-Solal A, D'Astous M, De S, Estrella-Holder E, Fremes S, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Masoudi FA, Ross HJ, Roussin A, Sussex B | display-authors = 6 | title = 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure | journal = The Canadian Journal of Cardiology | volume = 33 | issue = 11 | pages = 1342–1433 | date = November 2017 | pmid = 29111106 | doi = 10.1016/j.cjca.2017.08.022 | doi-access = free }}</ref><ref name="ESC2021"/>