A 63-year-old female is dizzy and sees yellow halos while on digoxin and metoprolol with renal failure, and develops a second-degree AV block. What is the most likely cause of her symptoms?

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Multiple Choice

A 63-year-old female is dizzy and sees yellow halos while on digoxin and metoprolol with renal failure, and develops a second-degree AV block. What is the most likely cause of her symptoms?

Digoxin toxicity is the key idea here. When kidney function is impaired, digoxin isn’t cleared well, so it accumulates in the body. The drug slows conduction through the AV node by increasing vagal tone and directly inhibiting AV nodal conduction, which can produce a second-degree AV block and bradycardia. The yellow halos are a classic visual disturbance associated with digoxin toxicity and help clinch the diagnosis. While metoprolol can also slow the heart, the combination of visual changes and an AV block points to digoxin accumulation rather than a simple bradycardia from a single drug effect. So, the most likely cause is digoxin toxicity due to reduced renal clearance.

Digoxin toxicity is the key idea here. When kidney function is impaired, digoxin isn’t cleared well, so it accumulates in the body. The drug slows conduction through the AV node by increasing vagal tone and directly inhibiting AV nodal conduction, which can produce a second-degree AV block and bradycardia. The yellow halos are a classic visual disturbance associated with digoxin toxicity and help clinch the diagnosis. While metoprolol can also slow the heart, the combination of visual changes and an AV block points to digoxin accumulation rather than a simple bradycardia from a single drug effect. So, the most likely cause is digoxin toxicity due to reduced renal clearance.

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