Cardiac medications

Question 1

What is digoxin used for?

Answer 1

Patients in AF who are also in heart failure or are hypotensive esp. in the elderly population

Question 2

What is the mechanism of digoxin?

Answer 2

1) It inhibits the Na/K ATPase ion pump in the myocardium and also has parasympathetic effects on the AV node
2) It is therefore negatively chronotropic and positively ionotropic i.e. slows HR but increases contractility

Question 3

What are the effects of digoxin on ECG?

Answer 3

1) Downsloping ST depression
2) T-wave changes (inversion)
3) Biphasic/flattened and shortened QT interval
4) Slight PR interval prolongation
5) Prominent U-waves
- these are NOT signs of digoxin toxicity

Question 4

What is the morphology of the QRS complex/ST segment with digoxin use described as?

Answer 4

Slurred, sagging, scooped and resembling either a reverse tick, hockey stick or Salvador Dali’s moustache

Question 5

What are the features of digoxin toxicity?

Answer 5

1) Nausea/vomiting
2) Diarrhoea
3) Blurred vision
4) Yellow/green discolouration of vision
5) Haloes in vision
6) Confusion
7) Fatigue
8) Palpitations
9) Syncope
10) Abdo pain
11) Arrhythmias

Question 6

What type of anti-arrhythmic is digoxin?

Answer 6

Rate control (for AF esp. in pts with HF)

Question 7

What can bisoprolol be used to treat?

Answer 7

AF, heart failure