Hi Richard!

Yours is an interesting case. Anyone looking at that ECG would have missed lead misplacement. As a rule, I always look at aVR and any positive wave in aVR alerts me for possible lead misplacement.

In addition, I have found that if more than one leads show all three waves (P, QRS, and T wave) inversion, then one must rule out lead misplacement. Normally, aVR is the only lead with all three waves inverted.

This can avoid most confusions while reporting ECGs.

I found another case report of similar lead misplacement for your review.

http://www.jecgonline.com/article/S0022-0736%2808%2900149-0/pdf

Hi Richard. 

How did your presentation go? Did you get any input about if this is a common missplacement? I don't belive I've ever seen during my 17 years in clinic, nor in our OSCE-exams of medical students on their ECG-registration station.

Cheers,

/Ulf

Thank you Ulf

Presentation went well

Again nobody seems to have come across it so it is impossible to estimate the size of the problem. In the meantime I can proceed with writing up my findings and spreading the good word.

Next step

1. Analyse other lead misplacements according to colour

2. Look at lead misplacement according to colour using the AHA colour coding

3. I have a lot more statictically significant data to look at and see if there is a pattern which might be recognisable

Thanks for your kind comments

Richard