22nd May 2025

An 84-year-old pensioner is brought in by ambulance with reduced GCS after being found by his carers in the morning.

An 84-year-old pensioner is brought in by ambulance with reduced GCS after being found by his carers in the morning. You are unable to get a history from him and the paramedics confirm there is no next of kin. His past medical history is significant for HFrEF, asthma and atrial fibrillation. His medications include apixaban 2.5mg BD, digoxin 62.5 mcg OD, eplerenone 25 mg OD and salbutamol inhaler. You look at his medical records and note a recent discharge letter from the previous week where he was admitted with decompensated HF and discharged on bumetanide 2 mg in the morning and 1mg in the afternoon. Blood tests, including renal function, have been sent. You request an ECG and CT head to rule out an intracranial haemorrhage. Which of the following ECG features is associated with digoxin toxicity? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.