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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Myocardial infarction with Paradoxical ST-segment elevation migration: a case study

Yu-An Chen1,2, Cheng-Chieh Huang1,3, Tsung-Han Lee1,3

  • 1Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.

International Journal of Emergency Medicine
|December 22, 2025
PubMed

Insights

Electrocardiogram electrode misplacement can mimic ST-segment elevation changes, leading to misdiagnosis of myocardial infarction. Recognizing unusual patterns and reviewing serial electrocardiograms helps identify accidental lead reversal.

Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt diagnosis.
  • Electrocardiograms (ECGs) are vital for STEMI diagnosis, but ST-segment elevation can migrate due to various factors.
  • Factors causing ST-segment elevation migration include lead misplacement, coronary vasospasm, thrombus migration, aortic dissection, and acute pericarditis.

Purpose of the Study:

  • To present a case of apparent ST-segment elevation migration due to limb lead reversal.
  • To emphasize the importance of accurate ECG interpretation in diagnosing myocardial infarction.
  • To highlight potential pitfalls in ECG interpretation and their clinical implications.

Main Methods:

  • A case presentation of a 47-year-old man with chest pain and dynamic ECG changes.
  • Analysis of serial electrocardiograms showing ST-segment elevation migration.
  • Confirmation of limb lead reversal through cardiac catheterization findings.

Main Results:

  • The observed ST-segment elevation migration was ultimately attributed to accidental limb lead reversal.
  • Cardiac catheterization findings corroborated the diagnosis suggested by the corrected ECG interpretation.
  • The case illustrates how electrode misplacement can lead to transient, misleading ECG findings.

Conclusions:

  • Accurate identification of ST-segment elevation is crucial for determining the culprit vessel in myocardial infarction.
  • Accidental ECG electrode misplacement can result in misdiagnosis.
  • Identifying misplacement involves recognizing unusual P-QRS patterns, using clear electrode labeling, and performing serial ECG reviews.
Abstract

Keywords:
Limbs reversalST-segment migrationWandering ST-segment elevation

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