Atrial fibrillation with digoxin effect

A 64 year old female resident of Villupuram, Tamilnadu came to the JIPMER cardiology OPD with chief complaints of Dyspnoea on exertion NYHA class III  along with cough and  white colour expectoration since last 3 days. History of palpitation since last three days, which are acute in onset, irregular in nature, occurring both at rest and on exertion. For all these complaints went to local government hospital, ECG, ECHOcardiography of the patient done which was suggestive of Rheumatic heart disease  with mitral regurgitation with atrial fibrillation with fast ventricular rate. Patient was started on digoxin, penicillin prophylaxis and referred to JIPMER cardiology department for further management. During evaluation in the cardiology OPD patient pulse was 110 beats per minute, BP-110/70 mmhg, pulse was irregularly irregular. CVS S1S2 present with pansystolic murmur at apical area. ECHOcardiography of the patient suggestive of Rheumatic heart diseases with severe mitral regurgitation. Patient ECG done which is shown below.

ECG 1

Narrow complex tachycardia, irregularly irregular, No visible P wave seen, heart rate around 140 beats per minute, there is ST segment depression with T wave inversion in lead II,III,avF, V4-V6 so the ECG is suggestive of atrial fibrillation with fast ventricular effect with  digoxin effect.

Lets see how to diagnose atrial fibrillation

Thank you.