METHODS/RESULTS: We 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.
CONCLUSION: Our 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.
CASE SUMMARY: A 52-year-old man developed an inferior ST-segment elevation myocardial infarction following a bee swarm attack. Standard thrombolysis with streptokinase triggered severe hemodynamic collapse and systemic hemorrhage. Upon recognizing KS, management was shifted to steroids and antihistamines, leading to complete recovery. Recurrence was documented 8 years later following an ant bite.
DISCUSSION: This case illustrates how standard acute coronary syndromes treatments, such as antigenic thrombolytics, can inadvertently exacerbate the allergic cascade in KS. It highlights the need to maintain a high index of suspicion when cardiac symptoms follow an allergic trigger.
TAKE-HOME MESSAGES: Avoid antigenic thrombolytics when KS is suspected to prevent iatrogenic clinical deterioration. Primary percutaneous coronary intervention and early allergy management are the preferred clinical strategies.