ECG Interpretation Confounders

Carey, Mary G.; Al-Zaiti, Salah S.; Kozik, Teri M.; Pelter, Michele M.

doi:10.4037/ajcc2013719

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ECG Puzzler| January 01 2013

ECG Interpretation Confounders

Mary G. Carey, RN, CNS, PhD;

Mary G. Carey, RN, CNS, PhD

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is a doctoral student at the School of Nursing at the State University of New York at Buffalo Teri Kozik is supervisor of cardiac research at St. Joseph's Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno

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Salah S. Al-Zaiti, RN, NP;

Salah S. Al-Zaiti, RN, NP

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is a doctoral student at the School of Nursing at the State University of New York at Buffalo Teri Kozik is supervisor of cardiac research at St. Joseph's Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno

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Teri M. Kozik, RN, CNS, PhD;

Teri M. Kozik, RN, CNS, PhD

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is a doctoral student at the School of Nursing at the State University of New York at Buffalo Teri Kozik is supervisor of cardiac research at St. Joseph's Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno

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Michele M. Pelter, RN, PhD

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is a doctoral student at the School of Nursing at the State University of New York at Buffalo Teri Kozik is supervisor of cardiac research at St. Joseph's Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno

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Am J Crit Care (2013) 22 (1): 77–78.

https://doi.org/10.4037/ajcc2013719

Scenario: A 45-year-old female executive arrived at the emergency room with complaints of substernal chest pressure and shortness of breath. She has no prior medical or surgical history, takes no medication, has a normal body mass index, and exercises regularly. Below is her 12-lead ECG obtained in the emergency room.

The ECG shows normal sinus rhythm at 99/min plus lateral ST changes (T wave inversion in V₅ and V₆). Although not diagnostic, it may suggest myocardial ischemia. Limb lead reversal prevents interpretation of the limb leads.

Lead reversal is frequent and has become more common as nonexperienced personnel replace trained ECG technicians.

This type of lead reversal affects all of the limb leads but lead I can be used to identify this error by checking for the following: (1) inverted QRS complex; (2) a striking Q wave; (3) inverted T wave; and (4) a notable inverted P...

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