Potential solutions for providing standard electrocardiogram recordings from nonstandard recording sites

For a 12-lead resting electrocardiogram (ECG) to be considered "standard," limb electrodes should be placed distally on the limbs. When resting ECGs are taken in conjunction with an ECG-monitoring situation, so-called monitoring sites (as described by Mason and Likar and also others) on the torso are used. Numerous publication have indicated that these ECGs are not identical with those recorded from distal sites, and this prohibits application of visual or computer-based interpretation criteria as well as serial comparison with standard ECGs. Loss of Q waves diagnostic for inferior wall myocardial infarction, as well as marked differences in frontal plane electrical axis, is the most commonly encountered problem with torso-recorded ECGs. This overview suggests 4 possible solutions to this dilemma.