In a patient with bradycardia and poor perfusion due to an overdose of digoxin, which medication is indicated as first-line treatment?

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Multiple Choice

In a patient with bradycardia and poor perfusion due to an overdose of digoxin, which medication is indicated as first-line treatment?

Bradycardia from digoxin toxicity is treated by countering the excess vagal (parasympathetic) influence on the heart. Atropine blocks muscarinic receptors, removing the vagal brake on the SA and AV nodes, which increases heart rate and improves cardiac output and perfusion. If atropine doesn’t adequately raise the rate or the patient remains unstable, more definitive steps such as pacing or giving digoxin-specific antibody fragments are used. Calcium-containing therapies are avoided in digoxin toxicity because extra calcium can worsen toxicity and provoke arrhythmias; lidocaine addresses ventricular arrhythmias rather than bradycardia; adenosine can worsen conduction problems in this context.

Bradycardia from digoxin toxicity is treated by countering the excess vagal (parasympathetic) influence on the heart. Atropine blocks muscarinic receptors, removing the vagal brake on the SA and AV nodes, which increases heart rate and improves cardiac output and perfusion. If atropine doesn’t adequately raise the rate or the patient remains unstable, more definitive steps such as pacing or giving digoxin-specific antibody fragments are used. Calcium-containing therapies are avoided in digoxin toxicity because extra calcium can worsen toxicity and provoke arrhythmias; lidocaine addresses ventricular arrhythmias rather than bradycardia; adenosine can worsen conduction problems in this context.

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