13: Lethargic Lady

Medical Mystery Case 13: Weakness and EKG Changes

An elderly woman with a history of depression, CHF and CAD presents with weakness and decreased PO intake for 10 days. History taking is difficult because she seems lethargic and only answers with “yes” and “no” but mostly “I don’t know”. She is short of breath but denies chest pain. On exam she does not co-operate much and is afebrile with normal vital signs but a dry mouth. Her EKG is shown below. Is this ACS or something else?

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Get Side Kicks: Emergency Medicine

ANSWER:

ANSWER: Digoxin Toxicity
This patient had the common triad diagnoses of UTI, dehydration, digoxin toxicity. Her digoxin level was 2.9. Her cardiac rhythm was stable and she responded well to IV fluids and antibiotics.
DIFFERENTIAL DIAGNOSIS OF ST-DEPRESSION from Side Kicks: Emergency Medicine
Ischemia: (flat, upsloping),
Reciprocal changes: (inferior > anterior),
Bundle Branch Block,
LVH,
Digoxin toxicity,
WPW,
Mitral valve prolapse,
Hypokalemia

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