Digoxin Dilemma

Abstract

Digoxin is a very commonly used drug in patients with systolic heart failure for enhancing cardiac contractility and in patients with supraventricular tachyarrhythmias for ventricular rate control. Due to its varied presentation and non specific symptoms, clinical suspicion should be high in order to diagnose a case of digoxin toxicity. Chronic toxicity is more common among the elderly and renal failure patients. The definitive treatment for severe digoxin toxicity is Fab fragments of digoxin antibody and there are specific indications for the same. However, due to its high cost and limited availability alternative measures may need to be used to manage severe intoxications. We present the case of an elderly patient with multiple co morbiditiess who presented to us in acute pulmonary edema and complete heart block. Serial ECGs reverted showing digoxin effect after symptomatic treatment and withdrawal of digoxin. In this case report, we discuss the various effects of digoxin and also the symptoms and signs of digoxin toxicity along with indications to use digoxin antibodies.