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Figure 1. A 71-year-old woman had recently undergone mitral-valve replacement after being treated with digoxin for 12 years for atrial fibrillation. After the operation, the same dose of digoxin was administered intravenously, despite rising creatinine levels. The 12-lead electrocardiogram in Panel A shows an alternating QRS axis that is characteristic of bidirectional ventricular tachycardia (arrows), an arrhythmia virtually diagnostic of digitalis toxicity. The serum digoxin level at the time of the electrocardiogram was 4.5 ng per milliliter (normal, 0.8 to 2.0). The tracing in Panel B, obtained after treatment with digoxin monoclonal antibody, shows resolution of the bidirectional ventricular . . . [Full Text of this Article] |
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