Reference no: EM133606377

Question 1

Sue Chalmers, is an 82 year old woman with a 50 year history of rheumatic mitral valve disease. She has been stabilised on digoxin for 10 years in a compensated state of heart failure (HF). Sue recently moved into a residential aged care facility because she was having difficulty caring for herself independently. On admission to the facility she was reviewed by a GP who found she was stable, noting an irregular pulse of 76 beats/min with a history of chronic atrial fibrillation supported by previous ECGs.

Three weeks after her arrival at the facility, Sue began to develop progressive weakness, dyspnoea on exertion, two-pillow orthopnoea, and peripheral pitting oedema (2+). These signs and symptoms became progressively worse and Sue needed to be transferred to hospital.

On admission to hospital, examination revealed heart rate of 96 beats/min with atrial fibrillation, third heart sounds, rales, wheezes, 2 + pitting oedema bilaterally up to the knees, elevated jugular venous pressure, cardiomegaly, weak pulses, and poor peripheral perfusion.

Discuss the most likely explanation for Sue's current symptoms.

Question 2

Sue's serum digoxin level was 0.12 ng/mL (therapeutic range: 0.5 to 2 ng/mL). She was treated with diuretics and redigitalised in the hospital with close cardiac monitoring.

After her condition stabilised, Sue reported that she knew she had been taking her digoxin every day because she recognised the pill. The only difference she could identify was that she was given the pill in the afternoon with a dish or ice cream, while at home she always took the digoxin on an empty stomach first thing in the morning.

The facility nursing staff confirmed that Sue received the drug daily in the afternoon and that it was the same brand name she had used at home.

Consider the factors that affect absorption of digoxin - How could the timing of the drug administration be related to the decreased serum digoxin levels not on admission to hospital?