Tag digoxin

ECG Case 086

70 yr old male who presented with general lethargy and postural dizziness. He has a collapse the evening prior and recently had a diarrhoeal illness. His medications include warfarin, metoprolol, frusemide, allopurinol, colchicine and digoxin. Describe and interpret this ECG. LITFL Top 100 ECG

Digoxin poisoning

Acute digoxin poisoning manifests with vomiting, hyperkalaemia and brady-tachyarrhythmias potentially leading to death, whereas chronic digoxin toxicity is far more insidious, still with gastrointestinal symptoms but in addition bradycardia and automaticity on the ECG.
CCC Critical Care compendium 340

Calcium, Digoxin Toxicity and ‘Stone Heart’ Theory

Administration of intravenous calcium has traditionally been considered a contra-indication for the treatment of hyperkalemia in the presence of digoxin toxicity. This is based on the ‘Stone Heart’ Theory: calcium may lead to an irreversible non-contractile state, due to impaired diastolic relaxation from calcium-troponin C binding
CCC Critical Care compendium 340

Digibind Antidote

Digibind: trade name for digoxin antidote containing Digoxin-specific antibody Fab fragments; prudent to administer based on a considered risk assessment and before the life-threatening manifestations of digoxin toxicity develop
CCC Critical Care compendium 340

Digoxin Toxicity

Digoxin toxicity is characterised by gastrointestinal distress, hyperkalemia and life-threatening dysryhthmias, including increased automaticity and AV nodal blockade
CCC Critical Care compendium 340


CLASS anti-arrhythmic (cardiac glycoside) MECHANISM OF ACTION inotropic effect increased automaticity negative dromotropy (slowing of AV conduction) increased vagal tone DIRECT:inhibition of Na/K ATPase on the cell surface-> increased intracellular Na+ and increased extracellular K+-> increased intracellular Ca2+ due to Na+/Ca2+ antiporter->…

having a dig…

the case. 87 year old female presents to your ED following an intentional overdose. She tells you that approximately 4 hours ago she ingested ‘most of [her] digoxin tablets’ that she bought earlier in the afternoon.