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A troublesome artifact
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ScienceDirect Journal of Electrocardiology xx (2015) xxx – xxx www.jecgonline.com
A troublesome artifact
Fig. 1. ECG on arrival at the emergency department.
Fig. 2. ECG obtained some minutes later.
A 46 year-old woman attended the emergency department for atypical chest pain and the electrocardiogram (ECG) shown in Fig. 1 was obtained. It was interpreted as acute coronary syndrome due to proximal occlusion of the left anterior descending artery. A repeat ECG performed several minutes later appeared completely normal (Fig. 2). The patient then underwent a stress test which proved negative, coronary angiography which was normal and ergonovine test to rule out coronary artery spasm which also proved negative. The changes in ST-T morphology, especially in limb leads, are due to the presence of complexes with different degrees of artifact. There are complexes in Fig. 1 that are very similar to non-artifactual complexes in Fig. 2 (arrows in both figures). All this together with the constant baseline wander strongly suggests that the first ECG is artifactual, probably caused by ECG leads “pulling” or patient limb movement during the first recording. Slight movement of the right and/or left arm and left leg can affect Wilson's central terminal which would explain the artifactual tracing from the precordial leads. Miguel Fiol-Sala, MD, PhD Armando Bethencourt, MD, PhD Hospital Universitario Son Espases, Palma de Mallorca, Spain Javier García-Niebla, RN Servicios Sanitarios del Área de Salud de El Hierro Valle del Golfo Health Center, Canary Islands, Spain Corresponding author at: Valle del Golfo Health Center C/ Marcos Luis Barrera 1, 38911 Frontera-El Hierro, Canary Islands, Spain E-mail address:[email protected] http://dx.doi.org/10.1016/j.jelectrocard.2015.08.029
0022-0736/© 2015 Elsevier Inc. All rights reserved.
ScienceDirect Journal of Electrocardiology xx (2015) xxx – xxx www.jecgonline.com
A troublesome artifact
Fig. 1. ECG on arrival at the emergency department.
Fig. 2. ECG obtained some minutes later.
A 46 year-old woman attended the emergency department for atypical chest pain and the electrocardiogram (ECG) shown in Fig. 1 was obtained. It was interpreted as acute coronary syndrome due to proximal occlusion of the left anterior descending artery. A repeat ECG performed several minutes later appeared completely normal (Fig. 2). The patient then underwent a stress test which proved negative, coronary angiography which was normal and ergonovine test to rule out coronary artery spasm which also proved negative. The changes in ST-T morphology, especially in limb leads, are due to the presence of complexes with different degrees of artifact. There are complexes in Fig. 1 that are very similar to non-artifactual complexes in Fig. 2 (arrows in both figures). All this together with the constant baseline wander strongly suggests that the first ECG is artifactual, probably caused by ECG leads “pulling” or patient limb movement during the first recording. Slight movement of the right and/or left arm and left leg can affect Wilson's central terminal which would explain the artifactual tracing from the precordial leads. Miguel Fiol-Sala, MD, PhD Armando Bethencourt, MD, PhD Hospital Universitario Son Espases, Palma de Mallorca, Spain Javier García-Niebla, RN Servicios Sanitarios del Área de Salud de El Hierro Valle del Golfo Health Center, Canary Islands, Spain Corresponding author at: Valle del Golfo Health Center C/ Marcos Luis Barrera 1, 38911 Frontera-El Hierro, Canary Islands, Spain E-mail address:[email protected] http://dx.doi.org/10.1016/j.jelectrocard.2015.08.029
0022-0736/© 2015 Elsevier Inc. All rights reserved.