|There is atrial fibrillation and profound ST depression. What else do you see? What else do you want to know?|
Here is the same ECG with some arrows:
|The QTc is 387 ms, very short for ischemia. There are also prominent U-waves (arrows).|
Digoxin results in ST depression with a short QT and often with prominent U-waves such as in this case. Hypokalemia results in a long QT with prominent U-waves.
Ischemia results in ST depression with a relatively long QT, and is likely to be accompanied by ischemic symptoms. Syncope is not an ischemic symptom; it is a relatively rare sole manifestation of ischemia.
It is important to keep in mind that ST depression due to digoxin happens at therapeutic concentrations, and is not a sign of Dig toxicity.