Right arm and left leg lead switch
Patient. 78 year old female was admitted 20 hours after chest pain. She was diagnosed having anterior MI. Cardiac catheterization showed high grade complex stenosis involving the distal left main and proximal LAD. There was also 80% stenosis of OM and PDA. She was thought not to be a good candidate for interventional treatment. Patient had recurrent severe chest pain and was taken back to cardiac catheterization laboratory where she underwent successful angioplasty and stenting of her distal left main and proximal LAD. Other diagnosis were type 2 diabetic, hypertension, hyperlipidemia and moderate bilateral renal artery disease.

The result is lead I and II are switched, lead aVL and aVF are switched. Lead III is inverted and there is no change in lead aVR.
This leads switch pattern is more difficult to recognize compare to the left and right arm leads switch.

Note that the lead switch in this case
change LAD (left axis deviation to RAD (right axis deviation). It also produce the diagnosis of inferior MI which the patient did not have. The set up like this case is uncommon but may lead to unneccesary cardiac care admission.

(See the correct lead placement ECG which actually shows LAD from LAFB, and of course there is no inferior MI)

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