COVID-19 Pandemic Impact on Physicians’ Decision-making: Digoxin Toxicity in View of Combination of Hydroxychloroquine and Azithromycin: A Case Report

Mohammed  Hamzah  Mezaal; Hasan Ali Farhan; Zainab Atiyah Dakhil

doi:10.3889/oamjms.2020.5021

Authors

Mohammed Hamzah Mezaal Ibn Al-Bitar Cardiac Centre, Baghdad, Iraq; Al-Yarmouk Teaching Hospital, Baghdad, Iraq
Hasan Ali Farhan Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq; Baghdad Heart Centre, Baghdad, Iraq
Zainab Atiyah Dakhil Department of Medicine, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

DOI:

https://doi.org/10.3889/oamjms.2020.5021

Keywords:

Digoxin toxicity, SARS-CoV2, Hydroxychloroquine, Azithromycin, Long QT

Abstract

BACKGROUND: Since the WHO declaration of COVID-19 being a global pandemic, the population in general and health-care providers, in particular, became under extraordinary pressure that remarkably impacts their decisions at multiple levels as all of us should make decisions quickly while being uncertain in many times.

CASE REPORT: We are reporting a 64-year-old lady with a medical history of atrial fibrillation and mitral regurgitation that treated with digoxin and warfarin therapy, she was suspected to be a COVID-19 case and prescribed empirical hydroxychloroquine and azithromycin combination without proper adjustment of her baseline therapy, accordingly she developed adverse effect of this combination in the form of digoxin toxicity and long QT, this case highlights how this unprecedented pandemic affects the decision-making of physicians.

CONCLUSION: We should be critical and vigilant in making a decision of prescription or marketing non-evidence-based therapy, and when we are obligated for this decision, we should take all precautions to minimize the adverse effects of these drugs.

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