Arrhythmias due to digoxin toxicity and acute management of patients with digoxin intoxication
DOI:
https://doi.org/10.6016/ZdravVestn.3386Keywords:
cardiac glycosides, digoxin, arrhythmia, heart failure, digoxin-specific antibody fragmentsAbstract
Synthetic cardiac glycosides are among the first medications still used in contemporary cardiology for adjuvant treatment of patients with symptomatic congestive heart failure with reduced ejection fraction and patients with atrial fibrillation or atrial undulation with tachycardic ventricular response resistant to standard therapy. Digoxin is the most recognized medication among synthetic cardiac glycosides. Despite the apparent decreasing trend in the number of cardiovascular patients prescribed with digoxin, intoxication with digoxin remains an important medical issue, particularly in patients with comorbidities and chronic course of intoxication, who manifest with subtle clinical presentation. Life-threatening arrhythmias are the leading cause of death among patients with digoxin intoxication. High serum digoxin concentration may cause a wide range of various arrhythmias. Proper understanding of the pathophysiological mechanism of arrhythmogenesis due to digoxin toxicity leads to early recognition of intoxicants with subtle clinical presentation, proper selection of antiarrhythmic drugs used in acute treatment, and, therefore, faster treatment and good clinical outcomes in these patients. Furthermore, specific treatment of these patients should be considered after consultation with a toxicologist. The following article presents arrhythmias due to digoxin toxicity and acute management of patients with digoxin intoxication, including the possibility of specific treatment.
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