Myocardial infarction with Paradoxical ST-segment elevation migration

Background: ST-elevation myocardial infarction is a life-threatening condition and the electrocardiogram is an essential tool for its prompt diagnosis. However, ST-segment elevation migration can occur due to several factors, including lead misplacement, coronary vasospasm, thrombus migration, aortic dissection, and acute pericarditis. Case presentation: A 47-year-old man with chest pain whose electrocardiogram revealed ST-segment elevation in different territories within one hour. The apparent ST-segment elevation migration was attributed to limb lead reversal, as confirmed by the cardiac catheterization findings, which were consistent with the second electrocardiogram. Conclusions: The accurate identification of ST-segment elevation is important to the cardiologist in order to determine the culprit vessel. This case highlights the accidental electrocardiogram electrode misplacement can result in misdiagnosis, which can be identified by recognizing unusual P-QRS pattern, using familiar-language electrode labeling, and performing serial electrocardiogram reviews.