This is an ECG of a 77-year-old woman.
 

1. Describe the ECG. 

2. Give two possible reasons for the ST changes. 

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College Answer

1 Regular rhythm rate 75. atrial pacing spike, t wave flattening with reverse tick

2 Ischaemia or digoxin

Discussion

Try as I might, I could not find an ECG with both atrial pacing apikes and digoxin toxicity.

I believe digoxin toxicity is probably the main issue here, so the ECG above is from the LITFL opus which discusses its characterisitc ECG effects.

Particularly memorable is their reference to Salvador Dali's moustache as resembling the "reverse tick" appearance of the digitalised ST segment.