Digoxin is a cardiac glycoside used widely in India for the treatment of heart failure and atrial fibrillation. Despite the apprehension of its use abroad, it continues to be a drug used extensively in our country when symptoms of heart failure remain despite use of other drugs. Digoxin toxicity can occur after an acute overdose or as a result of long-term therapy. It is also known to occur when serum digoxin levels are well within the therapeutic range owing to a variety of factors discussed below. Digoxin toxicity can present as almost any cardiac arrhythmia except rapidly conducted atrial dysrhythmias. Premature ventricular contractions and rarely, bidirectional ventricular tachycardia have be seen in this toxicity. Here we have reported a case of a 58 year old female, known case of RHD – post MVR with severe LV dysfunction presenting to the Emergency Department with progressively worsening palpitations and multiple epsiodes of vomiting over 1 day. On initial ED evaluation; patient was hypotensive and initial ECG was suggestive of first degree heart block. During further evaluation while in the ED; patient developed a wide complex regular tachycardia (Monomorphic VT) which was aborted only after DC cardioversion.