Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Perry Fisher, Sumit Som and Paul Schweitzer
Mount Sinai Beth Israel, USA
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Introduction: Electrocardiograph machines and clinicians can recognize much common lead misplacement. However, errors in arrangement of bipolar leads potentially create the unique predicament of pseudoinfarct ECG patterns. Discerning a limb lead misplacement from a true myocardial infarction is challenging and, unless there are a high clinical suspicion and an astute reader, is frequently overlooked. Here we illustrate a case of left arm (LA)/left leg (LL) lead reversal, and briefly review the mechanism and clinical importance of this under-recognized entity. Case Report: A 91 year old hypertensive male, in otherwise excellent physical health, was evaluated for an isolatedsyncopal episode. His vital signs and physical examination were unremarkable. A routineelectrocardiogram (ECG) was initially read as sinus rhythm, LVH with repolarization abnormality andinferior infarct (new as compared to old ECG from 2013). An echocardiogram later revealedresults within normal limits. Further analysis by expert electrocardiogram readers found that the (pseudo) inferior wall infarct pattern was due to a LA/LL lead reversal. Discussion: Although in our case this error was quickly identified and rectified this type of LA/LL reversalhas the potential to create confusion and in the right clinical setting can lead to expensive, unnecessaryand risky investigations and treatment leading to patient anxiety due to misinterpretation as an infarct. In our patient, due to LA/LL reversal, the lead IIIwas upside down; this lead to a pseudo inferior wall infarct pattern on the surface 12-lead ECG. Frequently, this error will lead to a near isoelectric line lead I, II or III, which might be the only sign ofLA/LL lead reversal in routine clinical practice. Computerized algorithms often lag in the automaticrecognition of this type of lead misplacement underlying the need for recognition of this subtle error.
Email: pefisher@CHPNET.ORG