February 7, 2023

One Messed-up Reversal


What is the interpretation of this cardiac telemetry ECG?

Image 1 - Image case

Lead I - P-/More R wave

Leads II, III & aVF - P- / like more Q waves

Lead aVR - P+/ More R (instead of more S)

Lead aVL - P+/ R=S (looked ok)

V lead - qr

Interpretation: ectopic atrial rhythm? Dextrocardia? Old inferior MI? Reversed leads?

So, again we checked lead placements and it was correct. After several maneuvers, we finally replaced the whole cable/wire system (not the telebox) and got the correct tracing.

Image 2 - Correct tracing

What happened?

I checked the wires and to my surprise...

Image 3 - Telemetry box connection

Messed-up reversal... I can't imagine that this was possible. Somebody must have cleaned each wires and placed it in this order:

RL (Green) > Chest lead (Brown)

RA (White) > LL (Red)

LA (Black) = ok

LL (Red) > RA (White)

Chest lead (Brown) > RL (Green)

For reference, this is supposed to be the color representation and the normal lead configuration.

Image 4- Normal lead placement/configuration

However, this is what happened here.

Image 5 - Lead Reversal Diagram

Lead I - LL/LA (instead of RA/LA)

Lead II - became reversed

Lead III - LA/RA (instead of LA/LL)

aVR - LL

aVL - ok

V lead - RL

So, this crazy things are possible... Now we know.

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