Objective To explore the effects of low dose digitalis on hemodynamics and heart rate variability (HRV) in patients with acute myocardial infarction (AMI) and heart failure. Methods 120 AMI patients with heart failure were divided into the experimental group and the control group with 60 cases in each group according to the random number table method. Both groups were treated with conventional anticoagulation, antiplatelet and lipid regulation after percutaneous coronary intervention (PCI) and reperfusion therapy. The experimental group was additionally given small dose of digitalis and the control group was not treated with this drug. The laboratory indexes of the two groups were examined before and after treatment, and the hemodynamic effects and HRV were assessed. Results After treatment, increased 2 grade of New York Heart Association (NYHA) cardiac function classification of the experimental group (4667%) was significantly higher than that of the control group (P＜0.05). The promotion of grade 1 of the experimental group and he control group were 46.67% and 48.33% (P＞0.05). There were no significant differences in the levels of plasma brain natriuretic peptide (BNP), tumor necrosis factor (TNFα), hemodynamic effects and HRV related indexes between the two groups before treatment (P＞0.05). Compared with before treatment, the plasma levels of BNP and TNFα were significantly decreased in both groups after treatment, and the levels of left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and cardiac index (CI) and the HRV related indexes were significantly improved (P＜0.05). The decreasing degree of plasma BNP and TNFα levels and the increasing degree of LVEF, SV, CO and CI were significantly higher in the experimental group than those in the control group (P＜0.05). And compared with the control group, the standard deviation of NN intervals (SDNN), the 24h continuous 5min segment mean normal RR interval standard deviation (SDANN), the root mean square continuous normal RR interval difference (rMSSD), the percentage of the number of heartbeats with two adjacent RR interval standard deviation≥50ms out of the heartbeats during information analysis (PNN50), low frequency power (LF), high frequency power (HF) were significantly higher while the LF/HF was significantly lower (P＜0.05). And there was no significant difference in the improvement effect of the above indexes in patients with different infarction sites in the experimental group after treatment (P＞005). Conclusion Small doses of digitalis can reduce the levels of plasma BNP and TNFαand promote heart function,hemodynamic effects and HRV in AMI patients with heart failure. The treatment effect is not affected by infarction sites.