Role of digoxin in Acyanotic Congenital Heart Disease(ACHD)

Digoxin is a drug indicated in heart failure associated with reduced heart function.

Its role in heart failure secondary to left to right shunt lesions in acyanotic congenital heart disease(ACHD), where systolic function of the myocardium is preserved, is not well defined. 

Use of digoxin in left-to-right shunts is recommended along with diuretics when the patient became symptomatic. There is no role for starting digoxin in an asymptomatic infant

The maintenance dose is given in twice daily doses for children <10 years and once daily for children >10 years. Digoxin “holiday” is generally not needed in children. Heart rhythm/ECG, Serum calcium, potassium and renal parameters need to be monitored.

If suspecting toxicity, ECG should be done and serum digoxin levels should be measured (sample taken at least 6 hours after the dose). Toxicity is usually seen at >2 ng/mL level.

A base-line ECG should always be recorded before initiating Digoxin therapy. 

Changes in ECG due to Digitalis Effect should not be confused with Digitalis toxicity.

  • Digitalis Effect
    • Down sloping ST depression with a characteristic “Salvador Dali sagging” appearanceFlattened. inverted. or biphasic T waves
    • Short QT interval
  • Digitalis Toxicity
    • Progressive AV block/Sinus bradycardia
    • SVT/VT

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