Vicious Rhythm of a Toxic Lady’s Glove

Digitalis glycosides are among the oldest drugs used in cardiology. Despite the reduction in digoxin use and improved therapeutic monitoring, digoxin toxicity remains a significant cause of morbidity and mortality due to its use in specific cardiac diseases. Suspicion of digoxin toxicity should involve supportive care, discontinuation of the drug and administration of digoxin-specific antibody fragments. We present a case of a 62-year-old female with heart failure, who was administered intravenous digoxin for her presentation with atrial fibrillation having a fast ventricular rate. Subsequently, the patient had a junctional rhythm which was mistaken for controlled ventricular rate. This led to bidirectional tachycardia, the sine qua non of digitoxicity. The renal parameters were deranged. The patient was managed with antiarrhythmics and dialysis.