Digoxin

• Digoxin has a relatively narrow therapeutic window ¹
  • For heart failure alone, the target serum levels should be between 0.5 and 1.0 ng/L.
  • For AF, the target range is higher (0.5-2.0 ng/L).

Digoxin Effect on ECG

Figure source: ¹

• Characteristic “sagging” ST segments
• Digoxin effect is due to therapeutic digoxin therapy and not necessarily related to toxicity. In other words, don’t assume patient is dig toxic if you see these Dali-style mustache ST-T changes

Footnotes

1. Tseng AS, Kowlgi GN, DeSimone CV. Antiarrhythmic Drugs for Atrial Fibrillation in the Outpatient Setting: Common Clinical Scenarios and Pearls for the Primary Care Clinician. Mayo Clin Proc. 2021 Aug;96(8):2230-2242. doi: 10.1016/j.mayocp.2021.01.010. Epub 2021 Jun 10. PMID: 34119307. ↩ ↩²