Answer - Case of the month (May 2011)

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E000541.jpg

Q: ECG of a 28 year old man with atypical chestpain. (Lead V3 is at V4R position). What is your diagnosis?

A. Antero-lateral MI

B. Pericarditis

C. Hyperkalemia

D. Wrong lead positioning

Answer:

D. Wrong lead positioning


Explanation: The extremity leads were positioned wrongly in this example resulting in enlarged QRS complexes and incorrect ST representation. The extremity leads were placed proximally on the chest (figure 1 lead_5). Correct lead positioning resulted in figure 2 (ECG_lead_3). The error could be reproduced, compare figures 3 and 4 (ECG_lead_1 and ECGlead_2).


Figure 1 Figure 2 Figure 3 Figure 4 E000541.jpg

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