Lead-Reversal ECG Simulating Myocardial Infarction  A Case Report and Literature Review

Amin, Mohammad Al; Chowdhury, Abdul Wadud; Ahmed, Mohsin; Sabah, Khandker Md Nurus; Haque, Hasna Fahmima; Kabir, Syed Rezwan; Islam, Kazi Nazrul; Saleh, Mohammad Abaye Deen

doi:10.3329/bhj.v31i2.32382

Cited by 3 publications

(7 citation statements)

References 3 publications

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“…Just for them, the WCT potential is correctly found to be unchanged (Table 1), although the reordered limb leads (trueI^, trueII^) in CCW rotation appear to be different (Table 3). Generally, all simulated reversals show that (trueI^, trueII^) leads, resulting from the ‘MSMinv’ transformation, are matching the expressions in other studies that have been derived by geometrical analysis of the leads, assuming “0” [6,12,19,21,22,24,35,36] or “near zero” signal <100 μV [5,7,8,38] for the lead between the active electrodes on both legs.…”

Section: Resultssupporting

confidence: 78%

“…This is theoretically proven by the ‘WSMinv’ transformation (12), where all swap matrices S (Table 2) are consequently applied, and zero WCT potential differences to the correct electrode position (ΔPWCT=0) are detected (Table 1). The rearranged limb leads (trueI^, trueII^) obtained by the ‘MSMinv’ transformation (Table 2) match the expressions in other studies, applying geometrical perspectives between leads (I, II, III) [5,12,21,24,36,37,38]. Furthermore, the unipolar chest lead V^X is unchanged for all simulated swap matrices S that corresponds to the real case scenario of unchanged WCT (Figure 2a,b).…”

Section: Resultssupporting

confidence: 72%

“…For this purpose, the formula for computation of the reordered leads (trueI^, trueII^, V^X) is directly compared to the published lead transformations. This simple approach is applicable only to reversals between peripheral electrodes, widely analyzed in the literature [5,7,12,21,24,36,37,38,43]. ECG electrode reversals with unknown lead transformations (such as reversals between limb and chest electrodes) are experimentally studied with a dedicated database (described in Section 3).…”

Section: Methodsmentioning

confidence: 99%

“…Errors in electrode placement can lead to significant ECG changes that could confuse physicians and affect the clinical diagnosis. Studies and case reports dedicated to this problem are further grouped in the following three categories according to the affected ECG electrodes: Reversals between limb electrodes are reported to provoke deep QS complexes and inverted T waves in leads (II, III, aVF) that could be misdiagnosed as old myocardial infarctions (MI) involving the inferior heart wall [5]. Right arm (RA) and left arm (LA) interchange is associated with inverted T waves in leads (I, aVL) suggestive of lateral wall MI [6] as well as indicative of ECG features of dextrocardia [7].…”

Section: Introductionmentioning

confidence: 99%

“…Reversals between limb electrodes are reported to provoke deep QS complexes and inverted T waves in leads (II, III, aVF) that could be misdiagnosed as old myocardial infarctions (MI) involving the inferior heart wall [5]. Right arm (RA) and left arm (LA) interchange is associated with inverted T waves in leads (I, aVL) suggestive of lateral wall MI [6] as well as indicative of ECG features of dextrocardia [7].…”

Section: Introductionmentioning

confidence: 99%

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Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

Krasteva

Jekova

Schmid³

2019

Sensors

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Electrode reversal errors in standard 12-lead electrocardiograms (ECG) can produce significant ECG changes and, in turn, misleading diagnoses. Their detection is important but mostly limited to the design of criteria using ECG databases with simulated reversals, without Wilson's central terminal (WCT) potential change. This is, to the best of our knowledge, the first study that presents an algebraic transformation for simulation of all possible ECG cable reversals, including those with displaced WCT, where most of the leads appear with distorted morphology. The simulation model of ECG electrode swaps and the resultant WCT potential change is derived in the standard 12-lead ECG setup. The transformation formulas are theoretically compared to known limb lead reversals and experimentally proven for unknown limb–chest electrode swaps using a 12-lead ECG database from 25 healthy volunteers (recordings without electrode swaps and with 5 unicolor pairs swaps, including red (right arm—C1), yellow (left arm—C2), green (left leg (LL) —C3), black (right leg (RL)—C5), all unicolor pairs). Two applications of the transformation are shown to be feasible: ‘Forward’ (simulation of reordered leads from correct leads) and ‘Inverse’ (reconstruction of correct leads from an ECG recorded with known electrode reversals). Deficiencies are found only when the ground RL electrode is swapped as this case requires guessing the unknown RL electrode potential. We suggest assuming that potential to be equal to that of the LL electrode. The ‘Forward’ transformation is important for comprehensive training platforms of humans and machines to reliably recognize simulated electrode swaps using the available resources of correctly recorded ECG databases. The ‘Inverse’ transformation can save time and costs for repeated ECG recordings by reconstructing the correct lead set if a lead swap is detected after the end of the recording. In cases when the electrode reversal is unknown but a prior correct ECG recording of the same patient is available, the ‘Inverse’ transformation is tested to detect the exact swapping of the electrodes with an accuracy of (96% to 100%).

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Section: Resultssupporting

confidence: 78%

Section: Resultssupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

Krasteva

Jekova

Schmid³

2019

Sensors

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ECG lead misplacement in the frontal and horizontal plane mimicking A myocardial infarction

Kaisbain,

Khoo,

Lim

2023

The American Journal of Emergency Medicine

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Reversal of Fortune: ECG STEMI Mimic

Sweeney

2021

Advanced Emergency Nursing Journal

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This column discusses what appears to be a lead reversal in a 12-lead electrocardiogram (ECG) of a routine low-risk chest pain evaluation in a 36-year-old man. A 12-lead ECG was completed and identified ST changes suggestive of ischemia in the inferior leads. Findings in the ECG suggested arm lead reversal that created an ST-segment elevation myocardial infarction (STEMI) mimic. Repeating the ECG and correcting the arm lead mistake identified a correction of these changes and identified an ECG more suggestive of benign early repolarization or J-point elevation. This case discusses the importance of identifying ECG findings that may suggest arm lead reversal and how sometimes misplaced leads could create the appearance of an STEMI. This is a review of the case, key points to interpreting ECGs for possible lead reversal and identifying the REVERSE mnemonic. Key words: arm lead reversal, early repolarization, ECG lead misplacement, J-point elevation, 12-lead ECG, low-risk chest pain, STEMI mimic, vector changes E MERGENCY MEDICINE is an art form, as well as a science. It requires the clinician to understand the abnormal while having a clear understanding of what is "normal." We are often specialists at being generalists in emergency medicine requiring clinicians to have broad knowledge base of a variety of topics. Where the art form becomes apparent is when a clinician is trying to interpret the utility of data. A white blood cell count of 14, a temperature of 100.1°F, a pulse oximetry of 90%-these marginal

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Lead-Reversal ECG Simulating Myocardial Infarction A Case Report and Literature Review

Cited by 3 publications

References 3 publications

Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

ECG lead misplacement in the frontal and horizontal plane mimicking A myocardial infarction

Reversal of Fortune: ECG STEMI Mimic

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Lead-Reversal ECG Simulating Myocardial Infarction  A Case Report and Literature Review

Cited by 3 publications

References 3 publications

Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

Simulating Arbitrary Electrode Reversals in Standard 12-lead ECG

ECG lead misplacement in the frontal and horizontal plane mimicking A myocardial infarction

Reversal of Fortune: ECG STEMI Mimic

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Product

Resources

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Lead-Reversal ECG Simulating Myocardial Infarction A Case Report and Literature Review