Differentials
Beta-blocker toxicity
SIGNS / SYMPTOMS
Hypotension, possible depressed mental status.
INVESTIGATIONS
ECG (slow ventricular rate, AV nodal blockade with associated dysrhythmias).
Blood glucose: hypoglycaemia.
Calcium-channel blocker toxicity
SIGNS / SYMPTOMS
Hypotension, usually normal mental status.
INVESTIGATIONS
ECG (slow ventricular rate, AV nodal blockade with associated dysrhythmias).
Blood glucose: hyperglycaemia.
Hypothermia
SIGNS / SYMPTOMS
Hypothermia, cool extremities, hypotension, ventricular dysrhythmias with rapid ventricular response.
INVESTIGATIONS
Normal or therapeutic serum digoxin concentration.
Ischaemic heart disease
SIGNS / SYMPTOMS
Hypotension, bradycardia, chest pain or discomfort, history of exertional dyspnoea with angina or anginal equivalent.
INVESTIGATIONS
Normal or therapeutic serum digoxin concentration.
Acute MI
SIGNS / SYMPTOMS
Chest discomfort and/or pain, dyspnoea, vomiting, pain characteristic of cardiac aetiology, bradycardia, hypotension.
INVESTIGATIONS
Normal or therapeutic serum digoxin concentration.
Hypothyroidism
SIGNS / SYMPTOMS
Cold intolerance, fatigue, depression, thinning of hair, lethargy, or abnormal menstrual cycle.
INVESTIGATIONS
Elevated TSH and decreased T4 levels are useful in the diagnosis.
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