Electrode misplacement

Electrode misplacement is a major source of error on the ECG. Some electrode misplacements are easier to spot than others. Comparing with an old ECG is often useful. Key signs of an electrode misplacement include an unusually flat lead (and the electrode hasn’t fallen off), unusually upside down leads, or two or more leads looking very similar. In the chest leads, swapping the electrodes around can cause a loss of normal R wave progression. If in doubt, repeat the ECG recording.

See also: Recording an ECG

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Variations

References

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In the ECGquest archives, this ECG has been tagged with: - Electrode misplacement Lead misplacement 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 11th February 2019 – Interpretation

This ECG is from a woman in her 70s who presented after an episode of chest pain.

This ECG shows flat lead II and reversal of III and aVF due to complex lead reversals. These changes resolved with correct lead position.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea LA/RA electrode reversal 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 17th December 2018 – Interpretation

This ECG is from a woman in her 50s who presented with chest pain and dyspnoea.

This ECG shows lead I is completely inverted due to electrode misplacement. The left and right arm electrodes have been swapped accidentally.

In the ECGquest archives, this ECG has been tagged with: - High V1/V2 misplacement RSR' Saddleback ST elevation 12-Lead Dr Smith's ECG Blog CC BY-NC
Saddleback ST Elevation. Is it STEMI? Is it type II Brugada?

This ECG is from a man in his 50s who presented with epigastric and chest pain.

This ECG shows saddleback ST elevation, but a RSR pattern in V1 that suggested lead misplacement. When the electrodes were repositioned there was no evidence of ischemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain High V1/V2 misplacement 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest Pain and Q-waves in V1 and V2. Is there previous septal MI?

This ECG is from a middle aged woman who presented with chest pain.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Electrode misplacement Normal Axis Lateral ST elevation Acute Lateral MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
A man in his 80s with chest pain

This ECG is from a man in his 80s who presented with chest pain and shortness of breath.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Electrode misplacement Left Axis Deviation Lateral ST elevation LAFB RBBB Acute Anterior MI Acute Lateral MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
A man in his 80s with chest pain

This ECG is from a man in his 80s who presented with chest pain and shortness of breath. This was the repeat ECG just before he arrested.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Extreme Axis LA/RA electrode reversal Sinus arrhythmia 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 15th October 2018 – Interpretation

This ECG is from a woman in her 40s who presented after an episode of chest pain.

In the ECGquest archives, this ECG has been tagged with: - Electrode misplacement Extreme Axis Normal rate Regular Inverted P waves Inverted T waves 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 24th September 2018 – Interpretation

This ECG is from a male in his teens who presented with episodes of his hands turning cold and blue for several hours at a time.

In the ECGquest archives, this ECG has been tagged with: - Chest pain High V1/V2 misplacement Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer Dr Stephen W. Smith CC BY-NC
A 50-something woman with chest pain and 2 “normal” ECGs at triage

This ECG is from a woman in her 50s who presented with one hour of chest tightness on a background of diabetes and hypertension.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Bradycardia Electrode Detachment Normal Axis Regular Anterior ST elevation Inferior ST elevation Lateral ST elevation Shark fin ST elevation Widespread ST elevation Left main occlusion 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 41 min later with crushing chest pain, just before arrest

This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG about 41 min after arrival, with recurrent crushing chest pain, just before he arrested.