Arterial Pulse Tapping Artifact Mimicking Acute Coronary Syndrome on Electrocardiogram

Introduction: Arterial pulse tapping artifact is a deceptive electrocardiographic artifact caused by mechanical movement of an electrode from arterial pulsation, which can produce pseudo-ischemic ST-T abnormalities. Case Presentation: An 88-year-old woman presented with substernal chest discomfort that was burning in quality and radiated to her back. Vital signs were stable. Physical examination was benign. Discussion: The presence of bizarre, nonphysiologic ST-T wave distortion, which spares a single limb lead, allowed for prompt recognition of arterial pulse tapping artifact. Recognizing this pattern—and confirmation with electrode repositioning—prevented misdiagnosis of acute coronary syndrome and inappropriate invasive angiography.