Palpitations in a 63-Year-Old Woman with Stage C Heart Failure-A Clinical Case Study

Palpitations in a 63-Year-Old Woman with Stage C Heart Failure-A Clinical Case Study

The most likely pathologic condition that increased the risk of digoxin toxicity in this patient is D. Hypothyroidism. Hypothyroidism significantly affects the pharmacokinetics of digoxin. The kidneys primarily eliminate digoxin, and thyroid hormones are crucial in regulating renal blood flow and glomerular filtration rate. In hypothyroidism, there is a reduction in these renal functions, leading to a decreased clearance of digoxin from the body (Cummings & Swoboda, 2022). As a result, the serum concentration of digoxin may rise, predisposing the patient to toxicity.

The laboratory data in the case report supports the diagnosis of hypothyroidism. The elevated Thyroid Stimulating Hormone (TSH) level of 15 ml/mL indicates inadequate thyroid hormone production, and the elevated T4 level of 42 ng/mL suggests an attempt by the body to compensate for the low thyroid hormone levels (Delitala et al., 2019). These abnormal thyroid function tests reinforce the presence of hypothyroidism in this patient.

Subsequently, the impact of hypothyroidism on digoxin metabolism is particularly significant because digoxin has a narrow therapeutic window. Even subtle changes in its concentration can lead to adverse effects, such as the junctional tachycardia observed in this patient (Delitala et al., 2019). Digoxin toxicity can manifest with various symptoms, including palpitations, and the patient’s presentation aligns with the known effects of elevated digoxin levels on the heart’s electrical conduction system (Cummings & Swoboda, 2022).

Considering the patient’s medical history of heart failure and the prescribed medications, the concurrent presence of hypothyroidism exacerbates the risk of digoxin toxicity. Healthcare providers should be vigilant in monitoring thyroid function in digoxin therapy patients, especially those with known risk factors such as heart failure (Delitala et al., 2019). In summary, hypothyroidism, as evidenced by elevated TSH and T4 levels, is the most probable pathologic condition contributing to the increased risk of digoxin toxicity in this patient. Monitoring and managing thyroid function in individuals on digoxin therapy is crucial to prevent adverse events associated with digoxin toxicity.

References

545. P., Scuteri, A., Maioli, M., Mangatia, P., Vilardi, L., & Erre, G. L. (2019). Subclinical hypothyroidism and cardiovascular risk factors. Minerva medica, 110(6), 530-545. https://doi.org/10.23736/s0026 4806.19.06292-x

Cummings, E. D., & Swoboda, H. D. (2022). Digoxin toxicity. In StatPearls [Internet]. StatPearls Publishing.a:link {text-decoration: none;}a:visited {text-decoration: none;
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A 63-year-old woman presented to the hospital with a chief complaint of palpitations. The woman was suffering from stage C heart failure and had been receiving digoxin, furosemide, and losartan for 6 months. Laboratory data on admission included potassium 3.9 mEq/L (normal 3.5−5.0 mEq/L), calcium 9.2 mg/dL (normal 8.5−10.5 mg/dL), magnesium 2.5 mEq/L (normal 1.5−2.0 mEq/L), total thyroxine (T4) 42 ng/mL (normal 50−110 ng/mL), thyroid-stimulating hormone (TSH) 15 mIU/mL (normal 0.5−5.5 mIU/mL).

An electrocardiogram showed junctional tachycardia, which, according to her nurse practitioner, was most likely due to digoxin treatment. Which of the following pathologic conditions most likely increased the risk of digoxin toxicity in this patient?

A. Hypermagnesemia
B. Hyperaldosteronism
C. Hyperparathyroidism
D. Concomitant furosemide treatment
E. Hypothyroidism

Please provide rationales and references for your selected answer choice.