ECG pattern resembling critical myocardial ischemia related to digoxin effect:—An unusual presentation at a crucial time!!

We report a case of a patient with a history of atrial fibrillation on digoxin who was in the peri-operative period after having undergone surgery for caecal gangrene. The patient had symptoms of acute onset severe intensity sub-sternal chest pain. The ECG performed immediately after the onset of pain revealed ST segment elevation in aVR and ST segment depression in multiple other leads often correlated with left main or proximal left anterior descending artery ischemia. Because of the risk of bleeding in loading anti-platelets and anti-coagulants, the patient was shifted to our center for an emergency angiogram which turned out to be normal and so were the subsequently performed cardiac enzymes. The pre-operative ECG did not show changes related to digoxin and the serum digoxin levels performed after the angiogram was in the upper level of normal range. Electrocardiographic changes disappeared with stopping of digoxin. The retrosternal pain was suspected to be related to gaseous distension of abdomen sometimes seen in post-laparotomy patients. The patient was managed conservatively. This case reports an unusual pattern of digoxin induced electrocardiographic abnormalities which had led to unnecessary panic and alarm and could have led to unnecessary treatment and interventions.
Source: Journal of Indian College of Cardiology - Category: Cardiology Source Type: research