Abstract
Electromechanical association is a very unique physiological type of ECG artifact caused by the radial artery pulse tapping. ECG presentation of this artifact may imitate primary repolarization changes characteristic for acute coronary syndrome or electrolyte abnormalities. The peculiarity of electromechanical association is the synchronization with regular cardiac cycles, making a diagnostic challenge even for experience physicians. The present case is a rare example of an ECG artifact localized in a specific pattern mimics ECG changes of acute myocardial infarction with ST elevation (STEMI), including reciprocal ST depression. Moreover, serial prehospital ECGs verify evolution from hyperacute T waves to true ST elevation, as we seen in acute myocardial infarction. The key for artefact recognition was the knowledge about ECG leads derivation and identification the affected electrode. Electromechanical association frequency is unknown: it may be common, but often unrecognized finding. So far, electromechanical association in serial ECGs wasn’t reported, as per our knowledge.