Rhythm Nation May 2015 Answer!

Rhythm Nation May 2015 Answer

Congratulations to Dr. Reza Roodsari!

This is indeed a case of digoxin toxicity.  Whenever you see “regularized a-fib,” that is, regular QRS intervals in a patient with permanent atrial fibrillation, think digoxin toxicity until proven otherwise.


How does digoxin work in the cell?

What do these effects have on the ECG? What happened to this patient? 

Due to high digoxin level, this patient received digoxin immune Fab and the repeat ECG is below:

afterdb

 

 

References:

Jon B. Cole and David J. Roberts. Cardiovascular Drugs. Rosen’s Emergency Medicine, Chapter 152, 1982-1993.e2

Hood, Jr. WB, Dans AL, Guyatt GH, Jaeschke R, McMurray JJV. Digitalis for treatment of heart failure in patients in sinus rhythm. Cochrane Database of Systematic Reviews 2014, Issue 4

Patel, V. et al. Digitalis Toxicity. Mescape reference. January 27, 2015.

Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/basics/digoxin-toxicity/

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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