A man in his 80s presented to the emergency department with a one day history of light headedness, dyspnoea, poor appetite, and fatigue. He had a history of hypertension, chronic atrial fibrillation, and atrial flutter, and his drug history included warfarin, metoprolol, digoxin, and furosemide. He reported a fever after experiencing symptoms of an upper respiratory tract infection and had taken a four day course of azithromycin empirically before presenting. In the emergency department, the patient’s blood pressure was 100/68 mm Hg and his heart rate was 49 beats/min. The results of laboratory tests were: brain natriuretic peptide 1560 ng/L (range 0-100 ng/L), serum creatinine 1.5 mg/dL (range 0.7 -1.3 mg/dL for man), serum potassium 3.8 mmol/L (range 3.5-5.5 mmol/L), and serum digoxin 4.23 nmol/L (range 1.02-2.56 nmol/L). A 12 lead electrocardiogram (ECG) was recorded at admission (fig 1). An ECG six months previously had shown atrial fibrillation, prominent U waves, and a controlled ventricular rate. The ECG was repeated two days after the …

中文翻译：

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药物相互作用的独特心电图发现

一名 80 多岁的男子因一天出现头晕、呼吸困难、食欲不振和疲劳而被送往急诊室。既往有高血压、慢性心房颤动、心房扑动病史，用药史包括华法林、美托洛尔、地高辛、呋塞米。他在出现上呼吸道感染症状后报告发烧，并在就诊前凭经验服用了四天的阿奇霉素疗程。在急诊科，患者血压为100/68毫米汞柱，心率为49次/分。实验室检查结果为：脑钠肽1560 ng/L（范围0-100 ng/L）、血清肌酐1.5 mg/dL（男性范围0.7 -1.3 mg/dL）、血清钾3.8 mmol/L（范围3.5-5.5 mmol/L），血清地高辛4.23 nmol/L（范围1.02-2.56 nmol/L）。入院时记录 12 导联心电图 (ECG)（图 1）。六个月前的心电图显示心房颤动、突出的 U 波和受控的心室率。两天后重复了心电图检查……