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
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.
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
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
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->…
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