The hea rate is nearly 125bpm. Notice the predominant T wave inversion in V1-V3. This is seen in myocardial ischemia. Diagnosis of myocardial injury needs elevated cardiac biomarkers. Digoxin leads to ST segment depression Digoxin toxicity leads to Ventricular Bigeminy Causes of T wave inversion Normal in children Myocardial ischemia Bundle branch block Ventricular hyperophy Pulmonary embolism Hyperophic obstructive cardiomyopathy Raised intracranial pressure