Clinical Manifestations of Digoxin Toxicity
Digoxin toxicity most commonly presents with gastrointestinal symptoms, visual disturbances, and cardiac arrhythmias. [1] Life-threatening bradyarrhythmias and ventricular arrhythmias can occur. [1]
Gastrointestinal Findings
- Anorexia, nausea, vomiting, and diarrhea may occur. [1]
- Abdominal pain may occur. [4]
Visual and Neurologic Findings
- Visual changes may include halos, blurred vision, and color-vision disturbances (yellow-green tinge). [1]
- Neurologic manifestations may include confusion, delirium, and generalized weakness or lethargy. [2]
Cardiac Findings
- Bradycardia and heart block of varying degrees may occur, including first-degree, second-degree (Wenckebach), and third-degree (including asystole). [1]
- Atrial tachycardia with atrioventricular block may occur. [1]
- Accelerated junctional (nodal) rhythm may occur. [1]
- Ventricular ectopy may occur, including unifocal or multiform premature ventricular contractions, particularly bigeminy or trigeminy. [1]
- Ventricular tachycardia and ventricular fibrillation may occur. [1]
- Bidirectional ventricular tachycardia is described as a characteristic manifestation. [3]
Laboratory and Severity Correlates
- Hyperkalemia may occur and is an indicator of severity, particularly in acute toxicity. [3]
- Symptoms and electrocardiographic findings are clinical hallmarks, and serum digoxin concentration does not reliably correlate with symptom severity in all cases. [3]
Commonly Associated High-Risk Patterns
- Life-threatening arrhythmias are typically characterized by high-grade atrioventricular block, bradyarrhythmia, ventricular tachycardia, ventricular fibrillation, or sinus arrest. [1]
- Severe sinus bradycardia or sinoatrial block may occur in patients with pre-existing sinus node disease. [1]
Immediate Recognition of Toxicity Requires Clinical Suspicion
- Clinical suspicion should increase with the combination of recent or excessive digoxin exposure plus gastrointestinal symptoms and visual changes with new cardiac rhythm abnormalities. [1]
- Hyperkalemia and major arrhythmias warrant urgent escalation of care due to risk of hemodynamic collapse. [1]