An ECG was done as shown below, with an initial concern of ischaemia.
What does the ECG show?
Using the ECG in 20 seconds approach the following are obvious:
- Irregularly irregular ie atrial fibrillation
- ST depression in I, II, aVL, V3-V6
What question do you want to ask next?
- “Are these changes old or new?”
- “Is the patient on digoxin?”
As it turns out the changes are old and the patient is on digoxin.
The changes on this ECG are not of classic morphology, so lets look at it a little more closely.
It’s important to understand the changes caused by digoxin
T WAVE CHANGES
The T wave can be inverted or flattened or biphasic(usually in V4-6). It can look upright in its terminal portion however in most cases this is a U wave.
There is usually QT shortening