Nodal Tachycardia Following Digitalis Overdosage (Stopped by Carotid Sinus Pressure): Report of Two Cases

Article1 April 1950NODAL TACHYCARDIA FOLLOWING DIGITALIS OVERDOSAGE (STOPPED BY CAROTID SINUS PRESSURE): REPORT OF TWO CASESLAWRENCE I. STELLAR, M.D., F.A.C.P.LAWRENCE I. STELLAR, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-32-4-717 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOne of the manifestations of digitalis overdosage may be the sudden occurrence of a regular tachycardia. Ventricular tachycardia has been described most commonly.1, 2, 3, 4, 5, 6, 7, 8 More rarely auricular tachycardia has been observed.6, 9, 10 Three cases of auricular flutter following toxic doses of digitalis have been reported,11, 12 whereas there has been only one reported case of nodal tachycardia.13This paper presents two additional cases of nodal tachycardia following digitalis therapy. Moreover, these patients demonstrated an unusual clinical course and an uncommon series of electrocardiograms that are deemed worth reporting.Without regard to etiology, in...Bibliography1. Gilchrist AR: Paroxysmal ventricular tachycardia, Am. Heart J. 1: 546-563, 1926. CrossrefGoogle Scholar2. Marvin HM: Paroxysmal ventricular tachycardia with alternating complexes due to digitalis intoxication, Am. Heart J. 4: 21-52, 1928. CrossrefGoogle Scholar3. Schwensen C: Ventricular tachycardia as the result of administration of digitalis, Heart 9: 199-205, 1922. Google Scholar4. Luten D: Clinical studies of digitalis. III. Advanced toxic rhythms, Arch. Int. Med. 35: 87-99, 1925. CrossrefGoogle Scholar5. Felberbaum D: Paroxysmal ventricular tachycardia, Am. J. M. Sc. 166: 211-222, 1923. CrossrefGoogle Scholar6. Luten D: Clinical studies of digitalis. II. Toxic rhythms with especial reference to the similarity between such rhythms in man and in the cat, Arch. Int. Med. 35: 74-86, 1925. CrossrefGoogle Scholar7. Reid WD: Ventricular ectopic tachycardia complicating digitalis therapy, Arch. Int. Med. 33: 23-34, 1924. CrossrefGoogle Scholar8. Howard T: Double tachycardia—co-existent auricular and ventricular tachycardia due to digitalis, Am. J. M. Sc. 173: 165-168, 1927. CrossrefGoogle Scholar9. RobinsonWilson GCFN: A quantitative study of the effect of digitalis on the heart of the cat, J. Pharmacol. and Exper. Therap. 10: 491-507, 1918. Google Scholar10. Stroud WD, Editor: The diagnosis and treatment of cardiovascular diseases, 1940, F. A. Davis Co., Philadelphia. Google Scholar11. McMillanBellet TMS: Auricular flutter: some of its clinical manifestations and its treatment, Am. J. M. Sc. 184: 33-57, 1932. CrossrefGoogle Scholar12. Wedd AM: Clinical auricular flutter, Ann. Clin. Med. 3: 69-92, 1924. Google Scholar13. GouleySouloff BAL: The use of quinidine in the treatment of arrhythmias and tachycardias caused by digitalis intoxication with a note on the possibility of "spontaneous redigitalization" following rapid diuresis, Am. Heart J. 16: 561-567, 1938. CrossrefGoogle Scholar14. Edmunds CW: The potency of digitalis preparations of the 1936 pharmacopeia, J. A. M. A. 113: 284-288, 1939. CrossrefGoogle Scholar15. Gold H: Digitalis: its action and usage, M. Ann. District of Columbia 10: 127-133, 162, 1941. Google Scholar16. BlandWhite EFPD: The strength of digitalis in clinical use, J. A. M. A. 117: 1243-1245, 1941. CrossrefGoogle Scholar17. EgglestonWyckoff CJ: The absorption of digitalis in man, Arch. Int. Med. 30: 133-157, 1922. CrossrefGoogle Scholar18. RobinsonWhiteEgglestonHatcher GCPDCRA: The therapeutic use of digitalis with especial reference to its intravenous injection, J. A. M. A. 83: 504-507, 1924. CrossrefGoogle Scholar19. GoodmanGilman LA: The pharmacological basis of therapeutics, 1941, Macmillan Co., New York. Google Scholar20. Garrey WE: The nature of fibrillary contraction of the heart. Its relation to tissue mass and form, Am. J. Physiol. 33: 397-414, 1914. CrossrefGoogle Scholar21. Resnik WH: Transient auricular fibrillation following digitalis therapy with observations upon the reaction to atropine, J. Clin. Investigation 1: 181-195, 1924. CrossrefMedlineGoogle Scholar22. SchnitkerLevine MASA: Presence of digitalis in body fluids of digitalized patients, Arch. Int. Med. 60: 240-250, 1937. CrossrefGoogle Scholar23. BestTaylor CHNB: The physiological basis of medical practice, 1937, Wm. Wood Co., Baltimore. Google Scholar24. Lewis T: The action of digitalis in cases of auricular fibrillation and flutter, Am. J. M. Sc. 164: 157-172, 1922. CrossrefGoogle Scholar25. Katz LN: Electrocardiography, 1941, Lea and Febiger, Philadelphia. Google Scholar26. StrongLevine GFSA: The irregularity of the ventricular rate in paroxysmal ventricular tachycardia, Heart 10: 125-131, 1923. Google Scholar27. StrongMunroe GFDS: Paroxysmal ventricular tachycardia with report of unusual case, Am. Heart J. 19: 486-491, 1940. CrossrefGoogle Scholar28. Richardson HB: A-V rhythm and digitalis, Arch. Int. Med. 29: 253-260, 1922. CrossrefGoogle Scholar29. CohnFraser AEFR: Paroxysmal tachycardia and the effect of stimulation of the vagus nerves by pressure, Heart 5: 93-104, 1913. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication March 25, 1948.From the First and Third Medical Services (Tufts) Boston City Hospital, and the Department of Medicine, Tufts Medical School, Boston, Massachusetts.Aided by a grant from the Charlton Fund. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInfluence of exercise on arrhythmias induced by digitalis-diuretic therapy in patients with atrial fibrillationUnusual Tolerance to DigitalisEffect of digitalis on conduction of the heartVentricular Fibrillation during Carotid-Sinus StimulationA-V Nodal Tachycardia with BlockThe toxicology of digitalis∗Arrhythmias and conduction disturbances due to digitalisTherapie der HerzinsuffizienzAcetyl strophanthidin sensitivity in dogs with congestive heart failureVariationen der Pulszeitstreuung beim Karotisdruckversuch am Menschen in Fällen von vegetativ-endokrinen RegulationsstörungenDigitalis Poisoning and Its TreatmentCritical rates in ventricular conduction 1 April 1950Volume 32, Issue 4Page: 717-727KeywordsElectrocardiographyEtiologyHospital medicineMedical servicesTachycardiaVentricular tachycardia ePublished: 1 December 2008 Issue Published: 1 April 1950 PDF downloadLoading ...