• Neerusha Kaisbain, Kenneth Kay Leong Khoo, and Wei Juan Lim.
• Cardiology Department, Queen Elizabeth II Hospital, Sabah, Malaysia.
• Am J Emerg Med. 2023 Dec 1; 74: 196.e1196.e4196.e1-196.e4.

Background/AimsElectrocardiogram (ECG) is an inexpensive, fundamental screening tool used in daily clinical practice. It is essential in the diagnosis of life-threatening conditions, such as acute myocardial infarctions, ventricular arrhythmias etc. However, ECG lead misplacement is a common technical error, which may translate into wrong interpretations, unnecessary investigations, and improper treatments.Methods/ResultsWe report a case of a multiple ECG lead misplacement made across two different planes of the heart, resulting in a bizarre series of ECG, mimicking an acute high lateral myocardial infarction. Multiple ECGs were done as there were abrupt changes compared to previous ECGS. Patient was pain free and administration of potentially harmful procedures and treatments were prevented.ConclusionOur case demonstrated the importance of high clinical suspicion in diagnosing ECG lead misplacement. It is the responsibility of both the healthcare workers who are performing and interpreting the ECG to be alert of a possible lead malposition, to prevent untoward consequences to the patient.Copyright © 2023 Elsevier Inc. All rights reserved.

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