A 60 year old with chest pain

I saw this in a stack of ECGs and recognized it immediately. What do you think?There is ST depression in the context of a normal QRS.  In other words, the ST depression is not secondary to LVH, LBBB, RBBB, RVH, WPW, or LV aneurysm.ST depression with a normal QRS has a small differential:1. Ischemia2. Hypokalemia3. Digoxin4. Normal variant.5. Anyone have any others?Ischemia has a relatively long QT intervalDigoxin results in a short QT interval.Digoxin is also associated with atrial fibrillation, as we see here.Digoxin ST depression has a " scooped " appearance.  It has been likened to Salvador Dali ' s mustache (see below)This ECG is pathognomonic for Digoxin effect, NOT toxicity.  Dig level was 0.6 ng/mL (0.4-2.0 is therapeutic)The patient had non-cardiac chest pain.Salvador Dali ' s mustache
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs