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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