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Myocardial Infarction Simulated From Improper Telemetry (MISFIT): An Autobiographical Case Report
Philip R Cohen1,2, Brent M Gudenkauf3
1Dermatology, University of California, Davis Medical Center, Sacramento, USA.
Cureus
|March 1, 2024
Summary
Electrocardiogram lead misplacement can mimic myocardial infarction, leading to misdiagnosis. A case study introduced MISFIT (myocardial infarction simulated from improper telemetry) to describe this diagnostic challenge.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Electrocardiograms (ECGs) assess heart rate, rhythm, and injury.
- Lead misplacement can lead to misinterpretation of ECG findings, mimicking myocardial infarction.
Observation:
- A patient with bradycardia and atrial fibrillation showed ECG changes suggestive of myocardial infarction post-treatment.
- Extensive cardiac workup, including troponin levels and echocardiogram, was normal.
Findings:
- An astute cardiologist identified left arm to right arm limb lead reversal as the cause of the false myocardial infarction findings.
- Repeat ECG in the office confirmed lead misplacement, with all infarction changes absent.
Implications:
- Clinicians must consider lead misplacement in ECG interpretation to avoid misdiagnosis.
- Incorrect ECG diagnoses due to lead misplacement can cause patient distress, unnecessary procedures, and increased healthcare costs.
- The acronym MISFIT (myocardial infarction simulated from improper telemetry) highlights this diagnostic pitfall.
