05-12-2009, 11:08 AM
A 96-year-old AAF was admitted from a nursing home with complaints of abdominal pain, N/V, dizziness, confusion and double vision for 5 days. She was discharged from the hospital just 4 days ago. Digoxin was started during that previous hospitalization for control of tachycardia in atrial fibrillation. One day prior to discharge, digoxin level was 1.8 mg/mL and digoxin dose was decreased to 125 mcg PO Q 48 hr.
PMH -Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure.
Medications
Metoprolol, Digoxin, ASA, lisinopril, Lasix, Coumadin, Nexium
Physical examination
In pain, combative and confused
VSS
Chest: Occasional bibasilar crackles
Cardiovascular System: Clear S1 and S2, irregularly irregular rhythm, HR 101 bpm
Abdomen: Soft, epigastric tenderness, no rebound, + BS
Extremities: No edema
What is the most likely diagnosis?
A - Digoxin toxicity.
B - Stroke.
C - Myocardial Infarction.
D - Ventricular Tach.
E - Arrythmia.
PMH -Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure.
Medications
Metoprolol, Digoxin, ASA, lisinopril, Lasix, Coumadin, Nexium
Physical examination
In pain, combative and confused
VSS
Chest: Occasional bibasilar crackles
Cardiovascular System: Clear S1 and S2, irregularly irregular rhythm, HR 101 bpm
Abdomen: Soft, epigastric tenderness, no rebound, + BS
Extremities: No edema
What is the most likely diagnosis?
A - Digoxin toxicity.
B - Stroke.
C - Myocardial Infarction.
D - Ventricular Tach.
E - Arrythmia.