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.

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ECG Library (39)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Electrode misplacement Lead misplacement 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 12-Lead LA/RA electrode reversal 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: - 12-Lead High V1/V2 misplacement RSR' Saddleback ST elevation 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 12-Lead High V1/V2 misplacement 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 12-Lead Electrode misplacement Lateral ST elevation Normal Axis Acute Lateral MI Dr Smith's ECG Blog 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 12-Lead Electrode misplacement Lateral ST elevation Left Axis Deviation LAFB RBBB Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog 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 12-Lead LA/RA electrode reversal Extreme Axis Sinus arrhythmia 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: - 12-Lead Electrode misplacement Extreme Axis Inverted P waves Inverted T waves Normal rate Regular 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 12-Lead High V1/V2 misplacement Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog 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 12-Lead Electrode Detachment Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion 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.