Journal of the Louisiana State Medical Society
DIAGNOSIS: Atrial tachycardia (214/min) with atrioven- tricular (AV) block and complete AV dissociation from junctional tachycardia (140/min), together with repolarization changes of digitalis, suggest digitalis toxicity. The P waves of the atrial tachycardia are directed in- feriorly. P waves and QRS complexes occur regularly and independently with no evidence of anterograde or retro- grade conduction. The rounded sagging of the ST segments, with short QT intervals (0.26 s) and low T waves, is typical of digitalis effect, and digitalis excess is known to produce both conduction abnormalities and tachyarrhythmias in patients with cardiac disease. 1 Thus, although every ar- rhythmia caused by digitalis may occur in its absence, few of them suggest digitalis toxicity as strongly as this double tachycardia with AV dissociation in a man taking the drug. REFERENCE
1. Wellens HJJ, Conover MB. The ECG in Emergency DecisionMaking . Philadelphia: WB Saunders;1992:139-159.
Dr. Glancy is a Professor and Dr. Ali is a former Fellow in the Sections of Cardiology, Departments of Medicine, Louisiana State University Health Sciences Center and the Interim LSU Hospital, New Orleans.
124 J La State Med Soc VOL 166 May/June 2014
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