Question

Seuss 2. Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of "skipping" heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula. (Learning Objective 1) a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities? b. For what clinical manifestations should you assess to correlate to his left-sided heart failure? c. How do his medications treat his congestive heart failure? d. How does the hypokalemia affect the effects of Digitalis?

Answer 1

Ans) 1 )The most common first sign of digoxin toxicity include fatigue, malaise, and visual disturbances. The classic features of digoxin toxicity are nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision).

2) Left-sided heart failure symptoms include: Awakening at night with shortness of breath. Shortness of breath during exercise or when lying flat. Chronic coughing or wheezing.

3) Digoxin (Lanoxin)
This medicine slows heart rate and might improve the pumping ability of the heart.

Lasix: medicines are called water pills because they remove excess fluid from the body to help you breathe easier and feel better.

Capoten (Captopril):
Angiotensin converting enzyme (ACE) inhibitors reduce the amount of heart-damaging hormones your body produces. They also dilate blood vessels and lower blood pressure to lessen the workload of the heart

Coreg (Carvedilol):
This medicine lower heart rate and blood pressure, and protect your heart from certain substances that can damage the heart. Beta blockers are often started at a very low dose and then are increased until a dose is reached that works best.

4) In states of hypokalemia, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.