Digoxin Toxicity

ECG Features of Digoxin Toxicity

The classic digoxin toxic dysrhythmia combines:

Other common dysrhythmias associated with digoxin toxicity include:

Pathophysiology

Digoxin can cause a multitude of dysrhythmias due to:

  • Increased automaticity (increased intracellular calcium)
  • Decreased AV conduction (increased vagal effects at the AV node)

Clinical features of Digoxin Toxicity
  • GIT: Nausea, vomiting, anorexia, diarrhoea
  • Visual: Blurred vision, yellow/green discolouration, haloes
  • CVS: Palpitations, syncope, dyspnoea
  • CNS: Confusion, dizziness, delirium, fatigue

ECG Examples
Example 1
Digoxin Toxicity Bigeminy 2

Bigeminy

  • Sinus rhythm with frequent PVCs in a pattern of ventricular bigeminy

Example 2
Digoxin toxicity PAT with block PVC

Paroxysmal atrial tachycardia with block

  • Atrial tachycardia with high-grade AV block and PVCs

Example 3
Digoxin toxicity Regularised atrial fibrillation AF

Regularised AF

  • Coarse atrial fibrillation with 3rd degree AV block and a junctional escape rhythm.

Example 4
Regularised AF digoxin toxicity

Regularised AF

  • Another example of regularised AF.

Example 5
Digoxin Toxicity atrial tachycardia with block and frequent PVC

“Paroxysmal” atrial tachycardia with block and frequent PVCs

  • This is a classic ECG of digoxin toxicity showing atrial tachycardia (P waves at 150 bpm), high-grade 2nd degree AV block (A:V ratio of 4:1) with frequent premature ventricular complexes.

Example 6
Atrial flutter with block digoxin toxicity

Atrial flutter with AV block

  • Atrial flutter with a slow ventricular rate due to digoxin toxicity.

Example 7
ECG Bidirectional ventricular tachycardia

Bidirectional Ventricular Tachycardia (VT)

  • Example of Bidirectional VT.
  • There is a broad complex tachycardia with a frontal-plane axis that alternates by 180 degrees with each successive beat.


Advanced Reading

Online

Textbooks


LITFL Further Reading

ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

2 Comments

  1. Thank you Ed and Robert for your hard work keeping all these pages up to date. It’s much appreciated.

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