A Case of Near-Fatal Chronic Digoxin Toxicity

Abstract

Cardiac glycosides remain an important part of the armamentarium of clinicians managing congestive cardiac failure, especially in the context of atrial fibrillation. However, cardiac glycosides have a narrow therapeutic window, and their toxic effects can result in life-threatening cardiac dysrhythmias.

We present a case of chronic cardiac glycoside toxicity presenting with acute-onset ventricular standstill. The patient required a brief period of cardiopulmonary resuscitation and emergent transcutaneous pacing followed by urgent single-chamber pacemaker implantation, digoxin-specific antibody fragments, and management of electrolytic abnormalities. The patient made a full neurological recovery, was extubated on day 1 following his bradyasystolic cardiopulmonary arrest, and was discharged on day 4 of his hospital admission. Here we consider the challenges in managing the critically unwell patient with cardiac glycoside toxicity, as well as the potential learning points generated from this case.