11.03.2017 Views

DR Medhat MRCP

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Digoxin and digoxin toxicity<br />

- Digoxin is cardiac glycoside used in AF & HF (rate control by action on AVN,improve<br />

symptoms of HF `not mortality` by ++ contraction by – Na/K ATPase pump).<br />

Digoxin toxicity: (level increases progressively from 1.5 to 3 mcg/l.)<br />

Features<br />

Generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green<br />

vision<br />

Arrhythmias (e.g. AV block, bradycardia).<br />

Precipitating factors<br />

Classically: hypokalaemia*<br />

Hypomagnesaemia<br />

Hypoalbuminaemia<br />

Hypothermia<br />

Hypothyroidism<br />

Increasing age<br />

Renal failure<br />

acidosis<br />

Hypercalcaemia<br />

Hypernatraemia<br />

Myocardial ischaemia<br />

Drugs :<br />

1. Verapamil, diltiazem<br />

2. Amiodarone, quinidine, procainamide<br />

3. Spironolactone (compete with digoxin for secretion in distal convoluted tubule<br />

therefore reduce its excretion). Also drugs which cause hypokalaemia e.g.<br />

thiazides and loop diuretics<br />

ECG features :<br />

ST ↓ and T↓ in V5-6 in a reversed tick pattern.<br />

Bradycardia<br />

Prolonged PR<br />

Shortened QT<br />

Arrhythmias, especially heart block or bigemini<br />

TTT : Digibind (digoxin immune FAB).<br />

26

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!