A 70-year-old diabetic woman who is on digoxin and a beta-blocker is presenting to the emergency department complaining of palpitation:

• Atrial fibrillation followed by restoration of sinus rhythm
• ST abnormality, possibly secondary to digoxin

Comment: This patient had been experiencing episodes of irregular rapid palpitation for the previous 3 months. This episode had lasted approximately 1 1/2 hr. The ST elevation in V1 and V2 is most likely reciprocal to the ST depression in V5 and V6. The patient had no chest pain and the cardiac enzymes were normal.