During ECG recording, which change most strongly suggests a therapeutic digitalis effect rather than myocardial ischemia?
Down-sloping ST depression with preserved T-wave polarity
The classical 'digitalis effect' on the ECG is a down-sloping ('scooped' or 'reverse-tick') ST-segment depression that still preserves the normal upright T-wave polarity, usually accompanied by a slightly shortened QT. It is seen in therapeutic concentrations, not toxicity.
ST elevation with Q waves, flat ST with Q waves and horizontal ST depression with symmetrical T inversion all suggest ischaemia or infarction rather than digitalis effect.
Hence, Down-sloping ST depression with preserved T-wave polarity.
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Digitalis exerts its effect primarily on:
Important Questions from Pharmacology
During ECG monitoring, which drug is most likely to cause bradycardia?
During high-dose vasopressor therapy, which ECG change most reliably indicates supply–demand ischemia due to increased afterload?
Which type of stress test involves the use of medication instead of physical exercise?
Which ECG change most reliably indicates quinidine toxicity?
What is the most appropriate initial management for a patient presenting with symptomatic bradyarrhythmia?
