A 57-year-old male with a history of coronary artery disease and prior stent placement presented for a routine follow-up. His clinical exam and echocardiogram were normal. His ECG showed an abnormality, with possible diagnoses including myocardial infarction, early repolarization, left ventricular hypertrophy, and others. However, pulse tapping on the ECG electrodes was identified as the likely cause of the changes seen, known as pulse tapping artifact. This phenomenon can occur due to the tapping of arterial pulses on electrodes and has been reported before in patients after percutaneous coronary interventions.

1. SPOTTER
DR VARSHITH K
DrNB CARDIOLOGY RESIDENT
ASTER MIMS

2. • 57yr MALE
• CAD
• S/P PTCA TO LAD & LCX - 2YEARS BACK
• COMES FOR ROUTINE FOLLOW UP
• CLINICAL EXAMINATION
• ECHO NORMAL

3. ECG

4. WHAT IS THE DIAGNOSIS ?

5. 2ND ECG

6. ARTERIAL PULSE TAPPING ARTIFACT

7. ST SEGMENT DIFFERENTIAL DIAGNOSIS
• MYOCARDIAL INFARCTION
• EARLY REPOLARIZATION
• LEFT VENTRICULAR HYPERTROPHY
• LEFT BUNDDLE BRANCH BLOCK
• ACUTE PERICARDITIS
• HYPERKALEMIA
• BRUGADA SYNDROME
• PULMONARY EMBOLISM
• ARTIFACT

8. PULSE TAPPING ARTIFACT
• THIS PHENOMENON OCCURS DUE TO TAPPING OF ARTERIAL PULSE
ON ECG ELECTRODES
• 1st reported by OZHAN et al in a post percutaneous coronary
intervention patient-----> attributed as silient ISCHEMIA. (2005)
• ASLANGER and BJERREGAARD described the mechanism of ECG
changes. (2011)

9. • Arteriovenous fistula
• Hyperdynamic circulation states
• Anemia
• Thyrotoxicosis
• Obesity
• Beriberi
• Sepsis
• Cirrhosis

10. THANK YOU