# The ECG shows characteristic ______ waves in the inferior leads, suggesting digitalis effect on the heart.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168421  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

The ECG shows characteristic ______ waves in the inferior leads, suggesting digitalis effect on the heart.

## 보기

1. sagging **✔ 정답**
2. inverted
3. peaked
4. notched
5. scooped

**정답: 1**

## 해설

Sagging ST segments (reverse checkmark sign) in inferior leads are a classic ECG finding of digitalis effect. This characteristic downsloping ST depression reflects the drug's effect on cardiac repolarization.

## 임상 시나리오

ECG Digitalis Effect:
- Sagging ST segments = "reverse checkmark" or "scooped" appearance
- Most prominent in leads II, III, aVF (inferior leads)
- ST depression with downward sloping
- Associated with therapeutic digoxin levels
- Caused by altered ventricular repolarization
- Other digitalis effects:
* Shortened QT interval
* T wave flattening/inversion
* PR interval prolongation
* Premature ventricular contractions
- Must differentiate from:
* Ischemic ST depression
* Electrolyte abnormalities
* Other drug effects
- Clinical monitoring:
* Serum digoxin levels
* Electrolytes (K+, Mg2+, Ca2+)
* Regular ECG assessment
* Signs of toxicity

## 핵심 개념

- **sagging** — Drooping or hanging downward, typically describing a downward curve or depression in ECG waves
- **inverted** — Turned upside down or reversed in direction, referring to waves that point downward instead of upward
- **peaked** — Having a pointed or sharp summit, describing waves with elevated, pointed tops
- **notched** — Having a small indentation or cut in the waveform, creating a V-shaped depression
- **scooped** — Having a concave or bowl-like depression in the waveform pattern

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