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Open Access ST-Segment Depression in Leads I and aVL: Artifactual or Pathophysiological Findings?

This article is Open Access under the terms of the Creative Commons CC BY licence.

The 12-lead electrocardiogram (ECG) is a routinely performed test but is susceptible to misinterpretation even by experienced physicians. We report a case of a 72-year-old lady with no prior cardiac history presented to our hospital with atypical chest pain. Her initial electrocardiogram shows an initial ST depression followed by positive deflections leads I and aVL. Non-physiological ST segment and T-wave changes are also observed in the precordial leads V2 to V6. By contrast, these abnormalities are notably absent in lead II. A repeat of the ECG taken 30 minutes later reveals the resolution of most abnormalities seen in the initial ECG on a background of high-frequency noise in the limb leads. She was referred to the cardiology department for further management. An urgent echocardiogram revealed no regional wall motion abnormalities with preserved ejection fraction, and her coronary angiogram revealed no significant coronary stenosis. This case illustrates the importance of understanding different factors that can cause ST segment abnormalities, notably artifactual changes that can mimic ST segment myocardial infarction.

Keywords: ST segment; artifact

Document Type: Research Article

Affiliations: 1: Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China 2: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China 3: Department of Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada

Publication date: December 1, 2021

This article was made available online on April 7, 2021 as a Fast Track article with title: "ST-Segment Depression in Leads I and aVL: Artifactual or Pathophysiological Findings?".

More about this publication?
  • Cardiovascular Innovations and Applications (CVIA) publishes focused articles and original clinical research that explore novel developments in cardiovascular disease, effective control and rehabilitation in cardiovascular disease, and promote cardiovascular innovations and applications for the betterment of public health globally. The journal publishes basic research that has clinical applicability in order to promote timely communication of the latest insights relating to coronary artery disease, heart failure, hypertension, cardiac arrhythmia, prevention of cardiovascular disease with a heavy emphasis on risk factor modification. Cardiovascular Innovations and Applications is the official journal of the Great Wall International Congress of Cardiology (GW-ICC). It aims to continue the work of the GW-ICC by providing a global scientific communication platform for cardiologists that bridges East and West.

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