Manifestation Of Digitalis Toxicity Research Articles

Photopsia as a manifestation of digitalis toxicity

Case report: To present a case of photopsia resulting from digoxin intoxication brought about by dehydration in a 72-year-old woman. Comments: Ophthalmologists may be the first clinicians to notice the symptoms of digitalis intoxication, which is potentially a life-threatening condition.

Rapid reversal of digitalis delirium using digoxin immune fab therapy

A fulminant psychiatric disturbance, as the sole noncardiac manifestation of digitalis toxicity, emerged in a 85-year-old woman during treatment for congestive heart failure. Described more than a century ago as "digitalis delirium," the disorder is characterized by severe agitation, delusional thinking, assaultive behavior, and even death. Digoxin immune Fab therapy was begun because of the fulminant psychiatric manifestations of this toxic state and the clear danger of self-inflicted physical harm. Within 3 h of therapy, a complete and spectacular resolution of all mental symptoms was observed.

Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of a multicenter study.

One hundred fifty patients with potentially life-threatening digitalis toxicity were treated with digoxin-specific antibody fragments (Fab) purified from immunoglobulin G produced in sheep. The dose of Fab fragments was equal to the amount of digoxin or digitoxin in the patient's body as estimated from medical histories or determinations of serum digoxin or digitoxin concentrations. The youngest patient received Fab fragments within several hours of birth, and the oldest patient was 94 years old. Seventy-five patients (50%) were receiving long-term digitalis therapy, 15 (10%) had taken a large overdose of digitalis accidentally, and 59 (39%) had ingested an overdose of digitalis with suicidal intent. The clinical response to Fab was unspecified in two cases, leaving 148 patients who could be evaluated. One hundred nineteen patients (80%) had resolution of all signs and symptoms of digitalis toxicity, 14 (10%) improved, and 15 (10%) showed no response. After termination of the Fab infusion, the median time to initial response was 19 minutes, and 75% of the patients had some evidence of a response by 60 minutes. There were only 14 patients with adverse events considered to possibly or probably have been caused by Fab; the most common events were rapid development of hypokalemia and exacerbation of congestive heart failure. No allergic reactions were identified in response to Fab treatment. Of patients who experienced cardiac arrest as a manifestation of digitalis toxicity, 54% survived hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Mobitz type II A-V block as a manifestation of digitalis toxicity

Summary A case of Mobitz type II A-V block induced by chronic digoxin toxicity in a conscious dog is reported. This arrhythmia disappeared shortly after the discontinuance of digitalis administration. We believe this is the first experimental evidence that digitalis can cause Mobitz type II block. It is therefore reasonable to suggest that digitalis therapy be temporarily discontinued in digitalized patients showing Mobitz type II block, since digitalis intoxication can manifest as Mobitz type II block.

Recognition and therapy of digitalis toxicity

Complicating the recognition of digitalis toxicity are certain electrophysiological phenomena which may result in arrhythmias which mimic toxic effects of the glycosides. In particular, the “rule of bigeminy”, aberrancy of intraventricular conduction, ”concealed” toxicity, concealed conduction into the AV junction, and exit block complicate the diagnosis of excessive digitalization. Of the various arrhythmias indued by digitalis, atrial tachycardia with block, nonparoxysmal junctional tachycardia, bidirectional “ventricular” tachycardia, ventricular premature systoles, ventricular tachycardias, multiple ectopic arrhythmias, AV dissociation, and the coexistance of conduction defects with ectopic beats or rhythms are of particular interest either (1) because of a high degree of correlation with digitalis toxicity or (2) because the recognition of the arrhythmia may present complexities which need consideration. The discussion in this review focuses on these complexities of arrhythmia interpretation as a manifestation of digitalis toxicity.

Conversion of atrial fibrillation to atrial flutter as a manifestation of digitalis toxicity ∗

A patient in whom atrial fibrillation was converted to atrial flutter as a manifestation of digitalis toxicity is described. The withdrawal of digitalis and the intravenous administration of potassium facilitated the re-establishment of the original rhythm.

Paroxysmal Atrial Tachycardia with Atrioventricular Block

Paroxysmal atrial tachycardia with block is a cardiac arrhythmia that is usually a manifestation of digitalis toxicity in patients with serious heart disease. The arrhythmia generally ends promptly after potassium administration and withdrawal of digitalis. Since the ventricular rates may be slow and regular, the arrhythmia may be difficult to recognize clinically. Atrial rates as slow as 115 per minute may be seen in cases which are otherwise typical of the condition. In our series associated pulmonary disease was present in 54 per cent and cor pulmonale in 27 per cent of the cases.

Atrial flutter as a manifestation of digitalis toxicity.

Although digitalis overdosage is known to produce a variety of atrial, junctional, and ventricular arrhythmias, atrial flutter due to digitalis intoxication has been rarely reported. The present paper reviews the literature and reports what appears to be the sixteenth case. The available information on the accepted cases of atrial flutter due to digitalis toxicity has been analyzed for clues as to when digitalis can be considered the cause of the flutter.

The ascendancy of digitoxin and renaissance of gitalin.

Excerpt With many physicians digitoxin has become a habit. When a digitalis preparation is indicated, digitoxin is almost reflexly prescribed, especially by the group of younger physicians who have...

Increasing Congestive Heart Failure: A Manifestation of Digitalis Toxicity

While it has been widely appreciated that myocardial function is increased with optimal digitalis dosage, it is not well recognized that toxic concentration may impair myocardial efficiency to the point of producing increased signs and symptoms of congestive heart failure. This was demonstrated in 15 patients who could be adequately maintained with a digitalis preparation. Upon increase in dosage, all patients presented an increase in congestive heart failure which subsided upon stopping or decreasing the digitalis dosage.