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ECG Findings

  • ST segment shortening and depression leading to a “scooped” appearance.

  • QT interval shortening.

  • PR interval prolongation.

  • Decreased T-wave amplitude.

  • Premature ventricular complexes are the most common dysrhythmia.

  • Bradydysrhythmias, heart block, especially with findings consistent with increased automaticity (atrial tachycardia with block, atrial fibrillation with slow ventricular response, accelerated junctional rhythms).

  • Bidirectional VT may rarely be seen (see Fig. 17.99).


  1. ECG changes associated with digoxin can be seen from therapeutic or toxic levels.

  2. ST-segment changes may be exaggerated by myocardial disease or tachycardia.

  3. An acute overdose of a digoxin is usually associated with hyperkalemia, which may increase the height of the T wave.

  4. Avoid calcium for treatment of hyperkalemia in the setting of digoxin toxicity as this may potentiate adverse effects of digoxin.


Digoxin Effect with Evidence of Toxicity. (ECG contributor: James V. Ritchie, MD.)


The “sagging” appearance of the ST segment (arrow) is characteristic of digoxin therapy and is not a sign of toxicity. However, this patient also has a sign of chronic digoxin toxicity. Atrial fibrillation is present, but the R-to-R interval has become regular. Digoxin toxicity has produced a total AV block but has also excited the AV node, producing a relatively accelerated junctional escape rate.

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