Digoxin and Symptomatic Bradyarrhythmia: the 'demon' or a 'red herring'

Area of Science:

• Cardiology
• Clinical Pharmacology
• Geriatrics

Background:

• Digoxin toxicity is a known cause of cardiac arrhythmias.
• Mobitz II atrioventricular block is a rare exception in digoxin toxicity.
• Elderly patients are more susceptible due to age-related physiological changes and comorbidities.

Purpose of the Study:

• To report a rare case of varied atrioventricular conduction blocks.
• To emphasize the protean manifestations of digoxin toxicity in the elderly.
• To discuss the interplay of digoxin, aging, and cardiac conduction.

Main Methods:

• Case report presentation.
• Review of patient's clinical history and medication.
• Analysis of cardiac rhythm and conduction abnormalities.

Main Results:

• The patient, a septuagenarian, developed various atrioventricular conduction blocks.
• These blocks occurred following the use of digoxin.
• The presentation underscores the variability and potential severity of digoxin toxicity.

Conclusions:

• Digoxin toxicity can manifest with diverse atrioventricular conduction blocks, even rare types.
• Elderly individuals with pre-existing cardiac conditions are at increased risk.
• Careful monitoring and consideration of drug interactions are crucial in geriatric patients on digoxin.