Atrial Fibrillation with Digoxin Effect

Atrial Fibrillation with Digoxin Effect

ECG Interpretation

  • Atrial fibrillation with a ventricular rate of about 80/min
  • Normal axis
  • Normal QRS complexes
  • Downward-sloping ST segments, best seen in leads V5–V6, but also present in lead I,II,III and aVF
  • Prominent U waves in leads V2–V3

Clinical Interpretation

The downward-sloping ST segments (the ‘reverse tick’) indicate that digoxin has been given. The ventricular rate seems well controlled.

The prominent U waves in leads V2–V3 are probably normal: U waves due to hypokalaemia are associated with flattened T waves.

What to do next?

Ask the patient about her appetite: the earliest symptom of digoxin toxicity is appetite loss, followed by nausea and vomiting.

If the patient is being treated with diuretics, check the serum potassium level – a low potassium level potentiates the effects of digoxin. If in doubt, the serum digoxin level is easily measured.

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