Answer - Case of the month (May 2011)

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). Correct lead positioning resulted in figure 2. The error could be reproduced, compare figures 3 and 4.

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  Figure 1

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  Figure 2

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  Figure 3

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  Figure 4