Digitalis toxicity is the most serious complication of Digitalis treatment in patients with heart failure .
Here we are going to discuss Digitalis toxicity regarding its diagnosis, people at risk,prevention and management.
Here we are going to discuss Digitalis toxicity regarding its diagnosis, people at risk,prevention and management.
Patients liable to toxicity
- Patients with Hypothyroidism and Hyperthyroidism .
- Patients with renal failure .
- Old age .
- Patients with hypokalemia or hypercalcemia .
Clinical picture of digitalis toxicity
- Vomiting, diarrhea.
- Arrhythmia (e.g extrasystole) specially bigeminy, ventricular tachycardia and heart block .
- Blurring of vision, altered colour vision (xanthopsia).
- ECG : arrhythmia, digitalis effect (sagging of S-T segment) .
- Diagnostic: The desired therapeutic serum level is 0.5 - 2 ng/rnl, it is > 2ng/rnl in case of digitalis toxicity.
Management of digitalis toxicity
- Stop digitalis.
- Stop diuretics.
- Give K (potassium).
- Treatment of arrhythmia.
- Digitalis Ab: Fab fragments of digitalis Ab --> Fab fragments digitalis complex --> excreted through the kidney.
- Haemopefusion for adsorption of digitalis .
How to avoid digitalis toxicity in risky patients ?
1. Decrease the dose (give half the dose) .
2. Drug holiday.
- Digitalis may lead to arrhythmias in cases of ischaemic heart disease,hyperthyroidism and myocarditis.
- The effect of digitalis in cases of cor pulmonale is poor !?