Digoxin Effect ECG Review

Digoxin can cause many different ECG abnormalities when supratherapeutic levels occur.

The classic digoxin effect appears as a downsloping ST segment depression, also known as the "reverse tick" or "reverse check" sign. 

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Digoxin toxicity can induce literally every arrhythmia except for rapidly conducted atrial arrhythmias (atrial fibrillation and atrial flutter). The classic arrhythmias seen during digoxin toxicity include atrial tachycardia with a 2:1 conduction, bidirectional ventricular tachycardia and atrial fibrillation with a slow ventricular response.

ECG Examples:

• Digoxin Effect ECG Example 1
• Digoxin Effect ECG Example 2
• Atrial Tachycardia with 2:1 AV Block ECG Example 1
• Atrial Tachycardia with 2:1 AV Block ECG Example 2
• Bidirectional Ventricular Tachycardia ECG Example

References:

1. Surawicz B, et al. Circulation. 2009;119:e235-240.

2. Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, Sixth Edition, Saunders, Philadelphia, 2008.