Abstract
1. 1. Three patients with long-standing atrial fibrillation were observed to have an increase in ventricular response to atrial fibrillation while taking large doses of digitalis. 2. 2. The increase in rate in each instance followed recent administration of a mercurial diuretic and was thought to be associated with loss of potassium during diuresis. 3. 3. Administration of intravenous potassium resulted in prompt and progressive slowing of the ventricular rate over a 2-hour period. 4. 4. In one case, digoxin given intravenously, after the rate had been slowed with potassium, caused the rate to increase. Additional potassium again effected slowing. 5. 5. The evidence suggests that during atrial fibrillation, digitalis toxicity may be paradoxically manifest by an increase in ventricular response without alteration of the pacemaker mechanism. 6. 6. Since this paradoxical response simulates a classical indication for digitalis, it represents a dangerous paradox if unrecognized as a toxic potential of the cardiac glycosides. 7. 7. This manifestation of toxicity seems prone to occur in patients with refractory congestive failure treated with rigid salt restriction, frequent mercurial diuretics, and large doses of digitalis.
Published Version
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