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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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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
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Summary
This summary is machine-generated.

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.

Keywords:
Limbs reversalST-segment migrationWandering ST-segment elevation

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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.