Aim and background: Electrocardiogram (ECG) artifacts are common but frequently overlooked issues that can greatly hinder the accurate interpretation of ECG tracings.These artifacts, which arise from sources unrelated to the heart's electrical activity, can resemble various arrhythmias or structural abnormalities.Among them, electromechanical association artifacts (EMAs) (arterial pulse tapping artifacts) arise from mechanical activity synchronized with the cardiac cycle and may mimic life-threatening cardiac conditions such as ST-elevation myocardial infarction (STEMI) or electrolyte abnormalities.If not correctly identified, they may result in unnecessary diagnostic procedures or inappropriate treatment.Case description: A 40-year-old male presented to our emergency department (ED) with an ECG obtained as a part of his pre-anesthetic evaluation for an elective cholecystectomy.The ECG showed abnormal T waves, for which the patient was referred to us.The patient was asymptomatic on presentation, and no abnormalities were noted during the examination.A repeat 12-lead ECG showed normal sinus rhythm and normal morphology of T waves.Based on the characteristic appearance of the T waves, it was diagnosed as arterial pulse tap artifacts, an ECG artifact originating from arterial pulsations getting transmitted to the electrodes.Clinical significance: Recognition of EMAs is essential for emergency physicians to avoid misdiagnosis of conditions such as STEMI or hyperkalemia and to prevent the unnecessary escalation of care.This case highlights the importance of careful ECG interpretation and the need to consider artifactual causes, especially when findings do not correlate with the clinical picture.
Suresh et al. (Mon,) studied this question.