Acute chest pain and a bizarre ECG

 Written by Pendell MeyersA middle aged adult presented with acute undifferentiated chest pain.Here is his ECG at triage:What do you think?I sent this ECG with no clinical information to Dr. McLaren, who replied simply " Artifact " . He is referring to an artifactual ECG pattern that corresponds with the cardiac cycle which is known as " arterial pulse tapping artifact. " See the discussion and links at the end of the post for more information, but this phenotype of ECG artifact is not yet well understood (to my knowledge). In some cases, it has been attributed to placement of an electrode near a pulsing anatomical structure, such as a dialysis fistula.The cath lab was activated for suspicion of posterolateral STEMI(+) OMI.Minutes later the ECG was repeated with new electrodes (there was no obvious problem or abnormality noticed from the first electrode placement):The cath lab was deactivated.All troponins were undetectable.No other significant pathology was found upon further chest pain workup.It seems almost certain to me that the first ECG does represent artifact simulating OMI, which I believe fits with the pattern of arterial pulse tapping artifact.Check out this case of similarly appearing arterial pulse tapping artifact:Bizarre (Hyperacute??) T-wavesSee more info on arterial pulse tapping artifact:Arterial pulse tapping artifacthttps://www.aclsmedicaltraining.com/blog/guide-to-understanding-ecg-artifact/This online article references the article below by Emre...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs