Question: What does this ECG show and what diagnosis is it usually associated with? (Hint: think toxicology)

Response: There are different arrhythmias that can be seen in digoxin toxicity, and this is one which is called bidirectional ventricular tachycardia. ECG demonstrations which can be seen in severe digoxin toxicity. One of the first steps in management of digoxin toxicity is intravenous fluids. There are various indications for “digi-bind” which include:

• Life-threatening or hemodynamically unstable arrhythmia
• VT, VF, asystole, complete heart block, Mobitz II heart block, symptomatic bradycardia
• Hypotension
• Hyperkalemia (K>5) following acute ingestion
• End-organ dysfunction (renal failure, AMS)
• Some advocate treating based on digoxin level or amount ingestion i.e. digoxin level > 10 ng/mL or more