Relation between serum digoxin concentration and the electrocardiogram

Abstract

Summary:The relation between serum digoxin concentration and the electrocardiogram was assessed by correlating computerized measurements of electrocardiographic parameters (PR, QRS, QT and QTc intervals, ST segment, and T-wave amplitude) with the serum digoxin concentration in 97 patients on digoxin maintenance therapy and in 40 nondigitalized control subjects. None of the patients had unstable ischemic heart disease, electrolyte disorders, medication known to influence the ST segment, and/or the presence of a bundle-branch block or ventricular hypertrophy. We found a trend toward lengthened PR interval and shortened QT and QTc intervals in digitalized versus nondigitalized patients. Increasing serum digoxin concentrations were associated with progressive depression of the ST segment and decreased T-wave amplitude (pCO.001). A normal ST segment in four leads (I, aVF, V5, V,) excluded the presence of a serum digoxin concentration > 1.3 ng/ml in our patients, whereas severe ST-segment depression with a J point of 1 1QO pV was a strong indicator for the presence of a serum digoxin concentration > 2.0 ng/ml in our selected patient population (specificity 99%, sensitivity 30%, predictive accuracy 85%). We conclude that computerized electrocardiographic analysis of the ST segment may provide clinically useful information for the management of selected patients on digitalis therapy and may therefore increase the diagnostic yield of the electrocardiogram in predicting the presence of higher serum digoxin concentrations in a small but significant percentage of patients.*Hugo E. Saner has been supported by a grant from the Swiss

Effect of digoxin on circadian blood pressure values in patients with congestive heart failure

“…The aim of the present study was to examine the effect of chronic digoxin treatment on either systolic and diastolic blood pressure in patients with mild congestive heart failure. As expected, digoxin led to a T-wave reduction as a common sign in ECG of the adequate therapeutic use of cardiac glycosides [13].…”

The Electrophysiological Effects of Cardiac Glycosides in Human iPSC-derived Cardiomyocytes and in Guinea Pig Isolated Hearts

“…The induction of altered Na + and Ca 2+ cycling by both cardiac glycosides created a proarrhythmic state. The significant shortening of FPDcf by ouabain and digoxin was consistent with their effects to reduce QT interval in the clinic [20,21] and in the isolated guinea pig hearts (Fig. 4).…”

Effects of digoxin and digitoxin on circadian blood pressure profile in healthy volunteers

“…ECG recordings at days 4 and 10 of digoxin and digitoxin treatment showed T-wave reduction as a typical sign of cardiac glycoside effect [14,15]. ECG recordings at days 4 and 10 of digoxin and digitoxin treatment showed T-wave reduction as a typical sign of cardiac glycoside effect [14,15].…”

“…The concentrations of digoxin and digitoxin achieved in the present study were in the middle of the therapeutic ranges in our laboratory (digoxin 0·8-2·0 ng mL ¹1 ; digitoxin 10-25 ng mL ¹1 ). ECG recordings at days 4 and 10 of digoxin and digitoxin treatment showed T-wave reduction as a typical sign of cardiac glycoside effect [14,15]. In Table 1 Effect of placebo and 4 and 10 days of treatment with digoxin on systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR).…”