Abstract
Unique electrocardiogram (ECG) patterns can be generated by inadvertent lead misplacements. The commonest of these is left arm-right arm (LA-RA) reversal leading to inverted lead I, right axis deviation and an upright aVR. Changes in placement of the neutral (right leg: RL) electrode with one of the LA or RA cables may produce more atypical patterns, which often mimic myocardial ischemia. We describe an unusual case wherein the ECG suggested an ectopic atrial rhythm and ischemic changes in the inferior leads. Closer scrutiny revealed a bilateral LA-LL and RA-RL (left arm- left leg and right arm- right leg) reversal. Familiarity and quick recognition of such ECG patterns shall help clinicians in avoiding diagnostic and therapeutic errors.
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