Digoxin Toxicity

ECG findings in patients on digoxin

• “Digoxin effect”

• Downsloping ST-segment depression with a characteristic sagging appearance (a.k.a Salvador Dali moustache)

• The presence of digoxin effect pattern on the ECG is not a marker of supratherapeutic digoxin levels or toxicity, but merely suggests that the patient is taking digoxin

• Digoxin toxicity

• Digoxin toxicity causes a multitude of dysrhythmias due to increased automaticity and decreased AV conduction

• Most common finding is frequent PVC’s

• Sinus bradycardia and AV blocks may be seen

• Slow “regularized” atrial fibrillation is a classic finding

• Regularized due to complete heart block and junctional or ventricular escape rhythm

• Bidirectional VT (rare)