digoxin and Atrioventricular-Block

Topics: Atrioventricular Block; Cardiac Complexes, Premature; Digoxin; Female; Fetus; Flecainide; Humans; Pregnancy; Sotalol; Tachycardia

Topics: Atrioventricular Block; Digitalis; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Humans; Plant Leaves; Plant Poisoning; Suicide, Attempted

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

The purpose of this study is to describe an in utero management strategy for fetuses with immune-mediated 2° or 3° atrioventricular (AV) block.. The management strategy as applied to 29 fetuses consisted of three parts. First, using fetal echocardiography and obstetrical ultrasound, we assessed fetal heart rate (FHR), heart failure, growth and a modified biophysical profile score (BPS) assessing fetal movement, breathing and tone. Second, we treated all fetuses with transplacental dexamethasone, adding terbutaline if the FHR was<56 bpm. Digoxin and/or intravenous immune globulin (IVIG) was added for progressive fetal heart failure. Third, we delivered fetuses by cesarean section for specific indications that included abnormal BPS, maternal/fetal conditions, progression of heart failure, or term pregnancy. We assessed perinatal survival, predictors of delivery and maternal/fetal complications in 29 fetuses with 3° (n=23) or 2° (n=6) AV block. There were no fetal deaths. In utero therapy included dexamethasone (n=29), terbutaline (n=13), digoxin (n=3) and/or IVIG (n=1). Delivery indications included term gestation (66%), fetal/maternal condition (14%), low BPS (10%) and progression of fetal heart failure (10%). An abnormal BPS correlated with urgent delivery.. These results suggest that applying this specific management strategy that begins in utero can improve perinatal outcome of immune-mediated AV block.

Topics: Atrioventricular Block; Cardiotonic Agents; Cesarean Section; Dexamethasone; Digoxin; Female; Fetal Diseases; Glucocorticoids; Heart Failure; Heart Rate, Fetal; Humans; Immunoglobulins, Intravenous; Maternal-Fetal Exchange; Pregnancy; Terbutaline; Ultrasonography, Prenatal

While digitoxicity secondary to therapeutic use is frequent, due to its distinctive appearance and unpleasant taste accidental ingestion of digitalis purpurea (foxglove) is uncommon. This report relates the case of two previously healthy individuals who inadvertently consumed significant quantities of digitalis in its plant form. Both men presented in first-degree atrioventricular block and had digoxin levels of 4.9 μg/litre, but were otherwise stable and made unremarkable recoveries with repeated dose activated charcoal.

Topics: Accidents; Adult; Atrioventricular Block; Diagnosis, Differential; Digitalis; Digoxin; Electrocardiography; Emergency Service, Hospital; Foodborne Diseases; Humans; Male; Middle Aged; Plant Poisoning; Taste

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Atrioventricular Block; Digoxin; Humans; Male

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

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Atrioventricular Block; Digoxin; Electrocardiography; Humans; Male; Tachycardia, Ectopic Atrial

Topics: Apocynaceae; Atrioventricular Block; Cardiac Glycosides; Digoxin; Humans; Male; Middle Aged; Plant Poisoning; Plants, Toxic; Seeds; Suicide, Attempted; Treatment Outcome