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Volume 15
Issue 2
10.3390/life15020215
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Case Report

Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State

by
Cristiana Bustea
1,
Andrei-Flavius Radu
1,2,*,
Cosmin Mihai Vesa
1,2,*,
Ada Radu
2,3,
Teodora Maria Bodog
2,
Ruxandra Florina Bodog
2,
Paula Bianca Maghiar
4 and
Adrian Marius Maghiar
2,4
1
Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
2
Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
3
Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
4
Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
*
Authors to whom correspondence should be addressed.
Life 2025, 15(2), 215; https://doi.org/10.3390/life15020215
Submission received: 9 January 2025 / Revised: 23 January 2025 / Accepted: 30 January 2025 / Published: 31 January 2025
(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application—2nd Edition)
Versions Notes

Abstract

Complete atrioventricular (AV) block is a severe conduction abnormality caused by intrinsic cardiac disease, ischemia, electrolyte imbalances, or drug interactions. Elderly patients on multiple medications are particularly vulnerable to polypharmacy-related interactions. This case report describes an 82-year-old female presenting to the emergency department with fatigue, syncope, and disorientation. Her medical history included atrial fibrillation, hypertension, and heart failure, with a medication regimen of digoxin 0.25 mg given daily 5 days out of 7, metoprolol 50 mg twice daily, lisinopril 10 mg daily, furosemide 40 mg daily, and spironolactone 50 mg daily. Clinical examination revealed bradycardia and a holosystolic murmur in the mitral valve area, while the electrocardiogram showed complete AV block at a ventricular rate of 35 bpm. Laboratory results indicated mild hyperkalemia (4.9 mmol/L). Suspecting a digoxin–beta-blocker interaction, antiarrhythmic therapy was discontinued. Within three days, the AV block resolved, transitioning to atrial fibrillation with a high ventricular rate. Bisoprolol was introduced for rate control, and hemodynamic stability was achieved. The patient was discharged with a revised medication regimen and showed no recurrence of AV block. This case emphasizes the importance of recognizing drug interactions as a reversible cause of AV block and using drug interaction checkers to manage polypharmacy, especially in elderly patients with multiple comorbidities. It also highlights the rare and paradoxical combination of atrial flutter and complete AV block.
Keywords: atrioventricular block; drug–drug interaction; digoxin toxicity; beta-blocker; hyperkalemia; online drug interaction checker atrioventricular block; drug–drug interaction; digoxin toxicity; beta-blocker; hyperkalemia; online drug interaction checker

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MDPI and ACS Style

Bustea, C.; Radu, A.-F.; Vesa, C.M.; Radu, A.; Bodog, T.M.; Bodog, R.F.; Maghiar, P.B.; Maghiar, A.M. Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State. Life 2025, 15, 215. https://doi.org/10.3390/life15020215

AMA Style

Bustea C, Radu A-F, Vesa CM, Radu A, Bodog TM, Bodog RF, Maghiar PB, Maghiar AM. Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State. Life. 2025; 15(2):215. https://doi.org/10.3390/life15020215

Chicago/Turabian Style

Bustea, Cristiana, Andrei-Flavius Radu, Cosmin Mihai Vesa, Ada Radu, Teodora Maria Bodog, Ruxandra Florina Bodog, Paula Bianca Maghiar, and Adrian Marius Maghiar. 2025. "Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State" Life 15, no. 2: 215. https://doi.org/10.3390/life15020215

APA Style

Bustea, C., Radu, A.-F., Vesa, C. M., Radu, A., Bodog, T. M., Bodog, R. F., Maghiar, P. B., & Maghiar, A. M. (2025). Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State. Life, 15(2), 215. https://doi.org/10.3390/life15020215

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