Download PDF
AJP Rep 2016; 06(03): e272-e276
DOI: 10.1055/s-0036-1586241
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Digoxin Therapy of Fetal Superior Ventricular Tachycardia: Are Digoxin Serum Levels Reliable?

Antonio F. Saad
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Luis Monsivais
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Luis D. Pacheco
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
2   Division of Surgical Critical Care, Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
› Author Affiliations
Further Information

Publication History

31 March 2016

24 June 2016

Publication Date:
10 August 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Background Despite its seldom occurrence, fetal tachycardia can lead to poor fetal outcomes including hydrops and fetal death. Management can be challenging and result in maternal adverse effects secondary to high serum drug levels required to achieve effective transplacental antiarrhythmic drug therapy.

Case A 33-year-old woman at 33 weeks of gestation with a diagnosis of a fetal sustained superior ventricular tachycardia developed chest pain, shortness of breath, and bigeminy on electrocardiogram secondary to digoxin toxicity despite subtherapeutic serum drug levels. She required supportive care with repletion of corresponding electrolyte abnormalities. After resolution of cardiac manifestations of digoxin toxicity, the patient was discharged home. The newborn was discharged at day 9 of life on maintenance amiodarone.

Conclusion We describe an interesting case of digoxin toxicity with cardiac manifestations of digoxin toxicity despite subtherapeutic serum drug levels. This case report emphasizes the significance of instituting an early diagnosis of digoxin toxicity during pregnancy, based not only on serum drug levels but also on clinical presentation. In cases of refractory supportive care, digoxin Fab fragment antibody administration should be considered. With timely diagnosis and treatment, excellent maternal and perinatal outcomes can be achieved.

Keywords

pregnancy - fetal SVT - digoxin - toxicity
 

  • References

  • 1 Owen P, Cameron A. Fetal tachyarrhythmias. Br J Hosp Med 1997; 58 (4) 142-144
    PubMedSearch in Google Scholar
  • 2 Vergani P, Mariani E, Ciriello E , et al. Fetal arrhythmias: natural history and management. Ultrasound Med Biol 2005; 31 (1) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 3 Jaeggi E. Electrophysiology for the perinatologist. In: Yagel S, Silverman NH, Gembruch U, eds. Fetal Cardiology, 2nd ed. New York: Informa Healthcare London; 2009: 435-447
    Search in Google Scholar
  • 4 Jaeggi E, Tulzer G. Pharmacological and interventional fetal cardiovascular treatment. In: Anderson RH, Baker EJ, Redington A, et al, eds. Paediatric Cardiology. 3rd ed. Philadelphia: Elsevier; 2009: 199
    Search in Google Scholar
  • 5 Donofrio MT, Moon-Grady AJ, Hornberger LK , et al; American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129 (21) 2183-2242
    CrossrefPubMedSearch in Google Scholar
  • 6 Smith TW, Antman EM, Friedman PL, Blatt CM, Marsh JD. Digitalis glycosides: mechanisms and manifestations of toxicity. Part I. Prog Cardiovasc Dis 1984; 26 (5) 413-458
    CrossrefPubMedSearch in Google Scholar
  • 7 Lewander WJ, Gaudreault P, Einhorn A, Henretig FM, Lacouture PG, Lovejoy Jr FH. Acute pediatric digoxin ingestion. A ten-year experience. Am J Dis Child 1986; 140 (8) 770-773
    CrossrefPubMedSearch in Google Scholar
  • 8 Graves SW, Brown B, Valdes Jr R. An endogenous digoxin-like substance in patients with renal impairment. Ann Intern Med 1983; 99 (5) 604-608
    CrossrefPubMedSearch in Google Scholar
  • 9 Bayer MJ. Recognition and management of digitalis intoxication: implications for emergency medicine. Am J Emerg Med 1991; 9 (2) (Suppl. 01) 29-32 , discussion 33–34
    PubMedSearch in Google Scholar