Digoxin

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Digoxin is a cardiac glycoside, which have two main effects:
  • Reduce the force of contractions
  • Reduce conduction through the AV node
 
It is most commonly used to control AF and atrial flutter, and in some cases, digoxin may also e used in heart failure.
 
Digoxin in Atrial fibrillation
  • Not the first line treatment in an variety of AF. Particularly in acute cases, it takes too long to act, and tachycardia may still persist even after the maximum dose.
  • See the AF article for more details
 
Digoxin Toxicty

Results from increased digoxin levels in the blood

  • Can be particularly difficult to identify as it is often similar to patient deterioration due to underlying disease
  • Is more likely in elderly patients

May occur in renal failure – as the drug is excreted by the kidneys

Symptoms:

  • Xanthopsia – a yellow ring / discolouration of the vision
  • Bradycardias
  • Ventricular ectopic beats
  • Heart block (various types)
  • VT/VF – rare

Investigations

  • Always check potassium! Hypokalaemia predisposes to cardiac side effects of digoxin, even when the levels of digoxin are low / therapeutic 

Sources