Your next patient is an 83 yo man who is brought to the emergency department by ambulance complaining of increasing nausea and feeling lethargic. He has a history of AF so you decide to do an ECG.

What does it show?

ECG features of digoxin toxicity:

Present on this ECG:

– AV block (can be any degree)

– AF with ventricular response < 60/min

Not present on this ECG:

– increased automaticity – ventricular ectopic beats / VT / various forms of supraventricular tachycardias with AV block

ECG of our patient post Digibind:

Other clinical features of digoxin toxicity:

– hypotension

– syncope

– nausea / vomiting / abdominal pain

– lethargy

– confusion / delirium

– aberration of colour vision (especially yellow – green), (xanthopsia) yellow haloes

With thanks to Conway.