Rare Manifestation of Digoxin Toxicity: Right Bundle Branch Block
1Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Journal of Basic and Clinical Pharmacy
|January 21, 2017
Summary
Severe digoxin toxicity can cause a new right bundle branch block (RBBB) in patients with heart failure. This rare EKG finding in digoxin toxicity requires emergency physician awareness.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Digoxin is a cardiac glycoside used for heart failure and arrhythmias.
- Digoxin toxicity can manifest with various cardiac and non-cardiac symptoms.
- Acute kidney injury can precipitate or worsen digoxin toxicity.
Observation:
- A 76-year-old female with heart failure presented with lethargy and abdominal pain.
- She developed hypotension, requiring fluid resuscitation and norepinephrine.
- Laboratory results revealed severe digoxin toxicity (29 ng/mL) and acute kidney injury.
Findings:
- Electrocardiogram (EKG) showed a new right bundle branch block (RBBB).
- Administration of Digibind (digoxin-specific antibody fragments) led to a decrease in digoxin level to 20 ng/mL.
- Repeat EKG demonstrated resolution of the RBBB.
Implications:
- This case highlights a rare association between digoxin toxicity and RBBB.
- Emergency physicians must consider RBBB as a potential EKG manifestation of digoxin toxicity.
- Prompt recognition and treatment of digoxin toxicity are crucial for resolving associated cardiac abnormalities.
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