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| ECG DIAGNOSIS |
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| Year : 2020 | Volume
: 8
| Issue : 4 | Page : 212-213 |
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ECG diagnosis
Neha Sukhani1, Suresh V Sagarad2
1 Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
2 Department of Cardiology, Rajiv Gandhi Super Speciality Hospital, Raichur, Karnataka, India
| Date of Submission | 07-Dec-2019 |
| Date of Acceptance | 25-Jan-2020 |
| Date of Web Publication | 23-Oct-2020 |
Correspondence Address:
Dr. Neha Sukhani
Department of Medicine, Raichur Institute of Medical Sciences, Raichur - 584 101, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AJIM.AJIM_84_19
How to cite this article:
Sukhani N, Sagarad SV. ECG diagnosis. APIK J Int Med 2020;8:212-3 |
| Image Section (Electrocardiography) | |  |
Q1. What are the electrocardiographic findings (electrocardiograph 1 [Figure 1] taken in emergency room and electrocardiography 2 [Figure 2] taken in intensive critical care unit)?
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| Answer | | |
Electrocardiography (ECG) 1 taken in the emergency room (ER) revealed sinus rhythm, ST elevation in II, III, AVF, and V5-6, and ST depression in I and AVL, suggesting inferolateral wall myocardial infarction (MI). ECG 2 taken in the intensive care unit revealed ST elevation in I and AVL, and ST depression in II, III, AVF, and V1-5, suggesting lateral wall MI. Within a span of 10–15 min, infarct territory was different which is unusual. It was found that limb leads LA and LL were reversed which was confirmed by taking repeat ECGs [Figure 3], [Figure 4], [Figure 5]. ECG 3 [Figure 3] was after placing leads correctly and ECG 4 [Figure 4] after again reversing the LA and LL leads and ECG 5 [Figure 5] after thrombolytic therapy and corrected leads.  | Figure 3: Electrocardiography in the intensive care unit after proper lead placement
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 | Figure 4: Electrocardiography in the intensive care unit with lead reversal (LA/LL)
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 | Figure 5: Electrocardiography in the intensive care unit after thrombolysis with correct lead placement
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ECG lead misplacement is not uncommon and may simulate pathologies such as ectopic atrial rhythm, myocardial ischemia, and infarction pattern and chamber enlargement. When the limb electrodes are exchanged without disturbing the neutral electrode (RL/N), Einthoven's triangle is flipped 180° or rotated resulting in leads that switch positions, become inverted, or remain unchanged. Exchanging one of the limb electrodes with the neutral electrode (RL/N) disrupts Einthoven's triangle and distorts the zero signal received from Wilson's central terminal altering the appearance of both limb leads and precordial leads. LA/LL reversal ECG findings in ST elevation myocardial infarction (STEMI) with LA/LL lead reversal are not described. With reversal of the LA and LL electrodes, Einthoven's triangle rotates 180° vertically around an axis formed by aVR. This has the following effects on the ECG: - Lead III becomes inverted
- Leads I and II switch places
- Leads aVL and aVF switch places
- Lead aVR remains unchanged.
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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