digitoxin and Bradycardia

One day after drinking what she thought to be a tea made from borage leaves a 72-year-old woman developed nausea, vomiting and diarrhoea, later also flickering in her eyes and palpitations. She was in a good general state with a blood pressure of 120/75 mm Hg and an irregular heart rate of 52/min. Physical examination was otherwise unremarkable. She had not been on any medication.. The usual laboratory tests were normal. The electrocardiogram showed atrial fibrillation with a slow ventricular rate with pauses of up to 1.5s. intermittently type I and II 2 degrees AV block, and depressed concave ST segments. The level of digoxin was 3.93 ng/ml, that of digitoxin 133.5 ng/ml.. The patient's symptoms quickly improved under symptomatic treatment. Further questioning suggested that she had probably mistaken foxglove leaves for those of borage when picking them to make a brew.. If cardiac arrhythmias have occurred after intake of self-picked herbal leaves one should consider digitalis intoxication resulting from misidentification.

Topics: Acute Disease; Aged; Atrial Fibrillation; Bradycardia; Diarrhea; Digitalis; Female; Humans; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Tea; Vomiting

Topics: Adams-Stokes Syndrome; Adolescent; Adult; Bradycardia; Cardiomegaly; Child; Child, Preschool; Digitalis; Europe; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Isoproterenol; Pacemaker, Artificial; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Tachycardia; United States

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Cardiac Complexes, Premature; Cardiomegaly; Clinical Trials as Topic; Coronary Disease; Digitalis Glycosides; Digitoxin; Heart Aneurysm; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Kidney Diseases; Lung Diseases; Middle Aged; Spinal Diseases; Tablets; Tachycardia

A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18 hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves. After viewing the images of comfrey and foxglove, it highlighted the possibility of mistaken ingestion of Digitalis, containing the organic forms of cardiac glycosides, such as digoxin and digitoxin. Raised serum digoxin levels confirmed this. The patient was haemodynamically stable, and given digoxin-binding antibodies. After 5 days of cardiac monitoring, her ECG returned to normal rhythm, and she was discharged home.

Topics: Accidents; Antibodies, Heterophile; Atrioventricular Block; Bradycardia; Comfrey; Digitalis; Digoxin; Electrocardiography; Female; Humans; Middle Aged; Plant Leaves; Plant Poisoning; Plants, Medicinal; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Vomiting

Topics: Aged; Beverages; Bradycardia; Cardiac Glycosides; Digitalis; Electrocardiography; Female; Humans

Topics: Anti-Arrhythmia Agents; Bradycardia; Diagnosis, Differential; Digitoxin; Dose-Response Relationship, Drug; Electrocardiography; Electrocardiography, Ambulatory; Female; Humans; Middle Aged; Nausea; Signal Processing, Computer-Assisted; Sinus Arrest, Cardiac; Syncope; Vomiting

Topics: Bradycardia; Cardiac Glycosides; Child, Preschool; Digitalis; Emergency Treatment; Female; Humans; Male; Middle Aged; Nerium; Plant Poisoning; Vomiting

Advanced Digitalis intoxication is a rare event, mainly associated with overdose in patients with Digitalis therapy. We report an unusual case of acute 'familiar' digitalis poisoning in three patients who had eaten potato dumplings flavoured with leaves of Borago officinalis L. unconsciously mixed with leaves of Digitalis purpurea L. A complicated clinical course with marked bradyarrhythmias was presented, with good evolution thanks to the use of digoxin-specific antibody Fab fragments. The theme of the domestic use of plants with medicinal effects has been treated and discussed.

Topics: Acute Disease; Adult; Antidotes; Bradycardia; Cardiac Glycosides; Charcoal; Digitalis; Electrocardiography; Female; Food Contamination; Heart Rate; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Plant Leaves; Poisoning

Topics: Adult; Atrioventricular Block; Bradycardia; Comfrey; Digitalis; Digoxin; Dizziness; Electrocardiography; Humans; Male; Nausea; Phytotherapy; Plant Leaves; Vision Disorders; Vomiting

Topics: Bradycardia; Diagnosis, Differential; Digitalis; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Middle Aged; Nausea; Plant Poisoning; Syncope; Vomiting

Topics: Adult; Anti-Arrhythmia Agents; Atropine; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Block; Humans; Infusions, Intravenous; Magnesium; Male; Phytotherapy; Plant Preparations

Topics: Adult; Bradycardia; Cardiotonic Agents; Chest Pain; Diagnosis, Differential; Digitoxin; Electrocardiography; Heart Block; Humans; Male; Myocardial Infarction; Poisoning; Suicide, Attempted

Topics: Adult; Bradycardia; Digitalis; Drug Costs; Female; Heart Block; Humans; Immunoglobulin Fab Fragments; Plants, Medicinal; Plants, Toxic; Suicide, Attempted

Topics: Bradycardia; Cardiotonic Agents; Digitoxin; Female; Humans; Middle Aged; Proscillaridin

A 82-year-old woman was admitted to hospital because of heart failure, vomiting, and pain in the right upper abdomen. During the past three months she had received treatment with 0.07 mg digitoxin twice daily. The ECG showed sinus bradycardia with intermittent complete sinoatrial block. On the basis of the history, clinical presentation and ECG findings digitalis intoxication was suspected. Digitoxin level was 65.23 ng/ml--far beyond the therapeutic range. Laboratory examinations revealed a marked thrombocytopenia (25,000/microliters). The patient was placed on cholestyramine (4g three times daily) to accelerate intestinal excretion of digitoxin. As there were no life-threatening complications there was no indication for treatment with digitalis-specific antibodies. On the 6th day after discontinuation of digitoxin treatment the platelet count showed a marked rise and returned to normal values as from the 12th day.

Topics: Aged; Aged, 80 and over; Bradycardia; Digitoxin; Electrocardiography; Female; Heart Block; Heart Failure; Humans; Thrombocytopenia

Topics: Bradycardia; Digitalis; Gastric Lavage; Humans; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Poisoning

Topics: Bradycardia; Digitoxin; Female; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy

Topics: Bradycardia; Digitoxin; Heart Rate; Humans; Prospective Studies

Plasma digoxin and digitoxin determination has proven to have an important bearing, particularly in patients with renal failure. It permits early detection of digitalis intoxication in the absence of marked clinical and ECG evidence, and adjustment of dosage accordingly. Also, in patent intoxication it makes it possible to select the right moment for resumption of therapy. To illustrate the importance of the method some cases are cited involving plasma digoxin and digitoxin determination.

Topics: Acute Kidney Injury; Bradycardia; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Kidney Failure, Chronic

Topics: Adenosine; Animals; Bradycardia; Bufanolides; Cardiac Glycosides; Cardiac Output; Digitalis Glycosides; Digitoxin; Digoxin; Guinea Pigs; Heart Arrest; Heart Block; Infusions, Parenteral; Lethal Dose 50; Mathematics; Ouabain; Plants, Medicinal; Time Factors

Topics: Adrenergic beta-Agonists; Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digitalis; Electrocardiography; Heart; Hemodynamics; Humans; Lidocaine; Phenytoin; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Quinidine; Tachycardia

Topics: Adult; Aged; Alkaline Phosphatase; Bilirubin; Bradycardia; Cardiac Complexes, Premature; Creatinine; Digitalis Glycosides; Digitoxin; Electrocardiography; Eye Manifestations; Female; Follow-Up Studies; Gastrointestinal Diseases; Heart Block; Humans; Male; Middle Aged; Poisoning; Tachycardia

Topics: Bradycardia; Digitalis; Electric Stimulation; Electrocardiography; Electrodes; Heart Conduction System; Heart Rate; Heart Ventricles; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic

Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Digitoxin; Electric Stimulation; Electrocardiography; Female; Heart Ventricles; Humans; Male; Quinidine; Syncope; Ventricular Fibrillation

Topics: Aged; Bradycardia; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Heart Auscultation; Heart Diseases; Hemodynamics; Humans; Male; Middle Aged; Muscle Contraction; Plants, Medicinal

Topics: Anesthetics, Local; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Barbiturates; Barium; Blood Pressure; Bradycardia; Chlorides; Conjunctiva; Cornea; Depression, Chemical; Digitoxin; Dogs; Electrocardiography; Epinephrine; Heart Rate; Hydrochloric Acid; Hypotension; Imipramine; Irritants; Ouabain; Petroleum; Proadifen; Rabbits; Reflex

Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Digitoxin; Electrocardiography; Female; Humans; Lidocaine; Pacemaker, Artificial; Postoperative Complications; Potassium Chloride; Procaine; Propranolol; Tachycardia; Ventricular Fibrillation

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Cardiac Complexes, Premature; Digitoxin; Electric Countershock; Electrocardiography; Electrolytes; Embolism; Female; Heart Failure; Heart Septal Defects, Atrial; Heparin; Humans; Hypokalemia; Intracranial Embolism and Thrombosis; Male; Middle Aged; Mitral Valve Stenosis; Postoperative Complications; Pulmonary Embolism; Quinidine; Spironolactone; Water-Electrolyte Balance

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Animals; Bradycardia; Digitalis Glycosides; Digitoxin; Dogs

Topics: Anesthesia, General; Animals; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Cats; Digitoxin; Dimethyl Sulfoxide; Drug Synergism; Electrocardiography; Female; Glycosides; Heart Rate; Infusions, Parenteral; Male; Ouabain; Plants, Medicinal; Ventricular Fibrillation

Topics: Adams-Stokes Syndrome; Bradycardia; Digitalis; Digoxin; Electrocardiography; Heart Arrest; Heart Rate; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Quinidine; Sympathomimetics

Topics: Arrhythmia, Sinus; Bradycardia; Digitalis; Electrocardiography; Heart Block; Heart Rate; Humans; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Sympatholytics; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Flutter; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Quinidine; Rauwolfia; Tachycardia; Tachycardia, Paroxysmal

Topics: Animals; Bradycardia; Cats; Digitoxin; Parasympathetic Nervous System; Reflex; Strophanthins; Vagotomy

Topics: Bradycardia; Delirium; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Gynecomastia; Humans; Lanatosides; Male; Neuritis; Paresthesia; Tachycardia; Thrombocytopenia; Toxicology; Trigeminal Neuralgia; Urticaria

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Blood Chemical Analysis; Blood Pressure; Blood Pressure Determination; Bradycardia; Calcium; Calcium, Dietary; Child; Digitalis; Digitalis Glycosides; Digoxin; Electrocardiography; Electroencephalography; Humans; Hydrogen-Ion Concentration; Infant; Potassium; Sodium; Toxicology; Urea; Water-Electrolyte Balance

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Arrest; Heart Block; Humans; Myocardial Infarction; Physiology; Sympathomimetics; Ventricular Fibrillation

Topics: Bradycardia; Digitalis; Heart Rate; Humans; Norepinephrine; Reserpine

Topics: Animals; Atropine; Bradycardia; Cats; Digitalis; Digitoxin

Topics: Animals; Aorta; Arteries; Bradycardia; Carotid Arteries; Carotid Artery, Common; Cats; Digitalis

Topics: Barium; Bradycardia; Calcium; Calcium, Dietary; Digitalis; Digitalis Glycosides; Epinephrine; Procaine; Reflex; Strophanthins

Topics: Bradycardia; Digitalis; Digitalis Glycosides; Ganglionic Blockers; Procaine; Reflex; Vomiting

Topics: Autonomic Agents; Autonomic Nervous System; Bradycardia; Digitalis; Digitalis Glycosides; Diphenhydramine; Neurocirculatory Asthenia; Reflex; Tetraethylammonium; Vomiting

Topics: Bradycardia; Digitalis; Digitalis Glycosides; Diuretics; Heart Failure; Heart Rate; Humans; Mercury; Organomercury Compounds

Topics: Arrhythmias, Cardiac; Bradycardia; Digitalis; Digitalis Glycosides; Heart Rate; Humans; Myocardial Contraction; Reflex