Recognition
- • Effect: 'reverse tick' ST depression, T inversion, QT shortening
- • Toxicity: any arrhythmia (bradycardia, AV block, atrial tachy with block, bidirectional VT)
Key findings
- • Bidirectional VT strongly suggests digoxin toxicity
- • Cannot judge toxicity from ECG alone — check level + K+
Clinical importance
- • Bidirectional VT → immediate Fab fragments
Management pearls
- • Correct K+, Mg
- • Atropine for bradycardia; avoid calcium in acute toxicity (relative)
- • Digoxin-specific Fab if life-threatening arrhythmia, K+ >5, ingestion >10 mg adult / 4 mg child
