Look before you place: A bizarre ECG artifact due to lead placement

Am J Emerg Med. 2023 May:67:194.e7-194.e10. doi: 10.1016/j.ajem.2023.03.034. Epub 2023 Mar 22.


The Electrocardiogram (ECG) is a readily available non-invasive test used in the evaluation of a patient with angina. ECG artifacts are common and stem from a number of different reasons including lead placement and must be identified to appropriately manage patients. We present the case of an elderly patient for whom an ECG was performed to evaluate chest pain showing an abnormal waveform concerning for an ST elevation myocardial infarction (STEMI). Closer inspection of the ECG revealed a characteristic pattern documented in the literature known as Aslanger's Sign seen when an ECG lead is placed over an artery.

Keywords: Aslanger's sign; Lead placement; Pseudo-myocardial infarction.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angina Pectoris
  • Artifacts*
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Electrocardiography
  • Humans
  • ST Elevation Myocardial Infarction* / diagnosis