Bidirectional Tachycardia after an Acute Intravenous Administration of Digitalis for a Suicidal Gesture

Abstract

Acute digoxin intoxication is a life-threating condition associated with severe cardiotoxicity. Female gender, age, low lean body mass, hypertension, and renal insufficiency may worsen the prognosis. Arrhythmias caused by digitalis glycosides are characterized by an increased automaticity coupled with concomitant conduction delay. Bidirectional tachycardia is pathognomonic of digoxin intoxication, but it is rarely observed. An 83-year-old woman was admitted to the Emergency Department after self-administration of 5 mg of digoxin i.v. for suicidal purpose. Her digoxin serum concentration was 17.4 ng/mL. The patient developed a bidirectional tachycardia and the Poison Control Center of the hospital provided digoxin immune fab. Bidirectional tachycardia quickly reversed and the patient remained stable throughout the hospital stay. This case shows that a multiple disciplinary approach, involving cardiologists and toxicologists, is essential for the management of digoxin intoxication. The optimal treatment of this rare event depends on the clinical conditions and on the serum drug concentration of the patient. Digoxin immune fab represents a safe, effective, and specific method for rapidly reversing digitalis cardiotoxicity and should be started as soon as the diagnosis is defined.

Bidirectional ventricular tachycardia in rheumatic fever reactivation

“…BVT had been reported previously in the case of fulminant and sub-acute myocarditis (Berte et al, 2008). VT had also been reported to be associated with acute phase of rheumatic fever and rheumatic heart disease (Freed et al, 1985;Shah et al, nd). This is the first reported case of BVT associated with subclinical carditis in RFR.…”

“…Bidirectional ventricular tachycardia (BVT) is a rare rhythm disorder characterized by an alternating beat-tobeat of QRS axis in the frontal plane lead. BVT was initially described in 1922 as a manifestation of digitalis toxicity (Sabatini et al, 2014), It has also been reported in the setting of familial hypokalemic periodic paralysis (Stubbs, 1976), Anderson-Tawil Syndrome (Morita et al, 2007;Chakraborty et al, 2015), fulminant myocarditis (Berte et al, 2008), familial catecholaminergic polymorphic Ventricular Tachycardia (CPVT) (Leenhardt et al, 1995;Lee et al, 2009;Femenia et al, 2012), acute ischemia (Wase et al, 2014), aconitine poisoning (Sheth et al, 2015), Cardiac Sarcoidosis (Benjamin et al, 2017), and several other conditions which predispose cardiac myocytes to delayed after depolarizations (DADs) and triggered activity (Baher et al, 2011). BVT is thought to be associated with poor prognosis regardless of underlying etiology.…”

Andersen–Tawil Syndrome

“…Severe digoxin toxicity, 48 BVT herbal aconite poisoning, 49 pheochromocytoma, 50,51 subacute myocarditis, 52 myocardial infarction/ischemia, 53 and ischemic cardiomyopathy during ablation in the absence of acute coronary syndrome. BVT is observed more frequently in elderly patients.…”