Internet diagnosis of digitalis toxicity
Marco Antonio Mercader1, Yousef Bader
1George Washington University, Medicine/Cardiology, 4-417, 2150 Penn Avenue NW, Washington, DC 20037, USA.
BMJ Case Reports
|June 21, 2011
Summary
A patient experienced a defibrillator shock due to digitalis toxicity, presenting with ventricular fibrillation and heart block. Web-based monitoring aided in diagnosing this critical condition, leading to prompt treatment with digoxin-specific antibodies.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Ischaemic cardiomyopathy and implantable cardioverter-defibrillator (ICD) implantation are common in elderly patients.
- Digitalis toxicity can manifest with complex cardiac arrhythmias and conduction abnormalities.
Purpose of the Study:
- To report a case of digitalis toxicity diagnosed using a web-based monitoring system in a patient with an ICD.
- To highlight the utility of remote monitoring in identifying and managing potentially life-threatening drug toxicity.
Main Methods:
- A 65-year-old male with an ICD experienced a shock at home.
- Device interrogation via a web-based monitoring system revealed ventricular fibrillation and complete heart block.
- Clinical presentation and laboratory findings confirmed digitalis toxicity.
Main Results:
- The patient exhibited frequent premature ventricular complexes, ventricular arrhythmias, and complete heart block, indicative of digitalis toxicity.
- Web-based monitoring facilitated the timely diagnosis of digitalis toxicity.
- Treatment with digoxin-specific Fab antibody fragments led to rapid improvement.
Conclusions:
- Web-based monitoring systems are valuable tools for the early detection of device-related events and drug toxicities.
- Prompt recognition and treatment of digitalis toxicity are crucial for patient outcomes.
- This case underscores the importance of considering drug toxicity in patients with ICDs presenting with arrhythmias and conduction disturbances.
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