Monday, August 8, 2011

Digitalis Effect

Today our amuse-bouche was an ECG with typical changes from digoxin.
The classic digitalis effect has 4 typical findings on ECG:
1.T-wave changes

  • Virtually any: flattening, inversion, other abnormal waveforms such as peaking of the terminal portion (seen in about 10% of patients)

2.QT-interval shortening

3.Sagging or “scooped” ST-segment with concomitant ST-segment depression

  • More pronounced in leads with tall R waves (e.g. lateral leads)

4.Increase in the U-wave amplitude

It is important to remember that these do not correlate with toxicity as they can be seen at levels well within normal therapeutic range.

For a good review on this and the other important arrythmias assiociated with digoxin toxixicy, see here.

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