I saw this in a stack of ECGs and recognized it immediately.
What do you think?
There is ST depression in the context of a normal QRS. In other words, the ST depression is not secondary to LVH, LBBB, RBBB, RVH, WPW, or LV aneurysm.
ST depression with a normal QRS has a small differential:
1. Ischemia
2. Hypokalemia
3. Digoxin
4. Normal variant.
5. Anyone have any others?
Ischemia has a relatively long QT interval
Digoxin results in a short QT interval.
Digoxin is also associated with atrial fibrillation, as we see here.
Digoxin ST depression has a “scooped” appearance. It has been likened to Salvador Dali’s mustache (see below)
This ECG is pathognomonic for Digoxin effect, NOT toxicity.
Dig level was 0.6 ng/mL (0.4-2.0 is therapeutic)
The patient had non-cardiac chest pain.
Salvador Dali’s mustache
Dr.Smith thanks for posting a very common ECG picture with very important and interesting information.
( A 60 year old with chest pain – Saturday, 6th Feb 2021). May I request you to discuss the method of calculating QTc in Atrial Fibrillation with irregular rhythm ?
With regards, Dr.R.Balasubramanian. Pondicherry . INDIA.
Thanks for your question. I just put up a different post which has a lot of information on that topic: https://hqmeded-ecg.blogspot.com/2021/02/what-to-do-when-atrial-fib-with-rvr.html
Nice Steve. for the first in time in maybe three years i got this one right. (and the differential too). not because i know ECG's. (i don't), but rather because i love Salvador Dali.