Digoxin Toxicity

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 Features of Digoxin Toxicity

Digoxin can cause a multitude of dysrhythmias due to:

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

The classic digoxin toxic dysrhythmia combines:

  • supraventricular tachycardia (due to increased automaticity)
  • slow ventricular response (due to decreased AV conduction)

Other common dysrhythmias associated with digoxin toxicity include:

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 tolcityh

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 tachycarida

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.

Related reading


LITFL Further Reading


Advanced 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 |

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