An elderly female arrives complaining of fatigue and weakness (easy right?) and a casual glance at the MAR shows the she is on digoxin for CHF. You notice she has a HR in the 50s and wonder if digoxin toxicity could be repsonsible for her symptoms. Lucky for you, you brushed up on this basics with this quick case review!

Thanks to Dr. Julia Moon for a great review of digitalis toxicity in conference this week - here's some reinforcement of the basics. 

• Digitalis inactivates the Na-K-ATPase pump to increase intracellular calcium and extracellular potassium, causing + inoptropy, hence usage in CHF patients
• Dig also increases vagal tone and decreases conduction through the AV node, hence usage in atrial fibrillation. In toxic doses, this is what leads to bradydysrhythmias

Toxicity can either be Acute or Chronic: