Digoxin
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Introduction

Digoxin is a cardiac glycoside, which have two main effects:
  • Increases the force of contractions (through increased intracellular Ca2+​)
  • Reduce conduction through the AV node
It is most commonly used to control AF and atrial flutter, and in some cases, digoxin may also be used in heart failure.

Digoxin in Atrial fibrillation

  • Dioxin is 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. It is also less effective than many other agents, and unlike many of the other drug choices, it carries a risk of toxicity
  • It is most commonly used in milder cases of AF in older patients, in whom other drugs may be less well tolerated

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

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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