Here is a graphic I created to help explain Sgarbossa’s criteria for identifying acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) or paced rhythm.
In a previous article I showed this graphic which was created using PowerPoint.
Here is a similar graphic I created this morning by cropping actual ECGs that meet the criteria.
These are the features we should be looking for with LBBB and ventricular paced rhythms!
See also:
80 year old male CC: Chest pain
Excessive discordance as a marker of acute STEMI in LBBB
80 year old male CC: Chest pain – Conclusion
Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part I
Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part II
“New” LBBB – What’s the big deal?
Discordant ST-segment elevation in LBBB or paced rhythm
Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)
62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)
58 year old female CC: Chest pain
58 year old female CC: Chest pain – Conclusion (meets all 3 of Sgarbossa’s criteria)
THANKS ALOT FOR THIS GRAPH
You're welcome, Dr. Sonnet!Tom
Very interesting Tom… Well done with the graphics and explanation!
Jason – Thanks, dude! This is an important concept and one that all paramedics need to eventually master if we are going to do our patients justice, IMHO.Of course, paramedics aren't the only ones! ED physicians should know it, too.Tom
tomi am a registered nurse in a cath lab in western pa. i just discovered your blog recently.excellent work.i have collected over 75 acute mi 12 lead ekg's with the corresponding angiogram of the culprit lesions.saturday we did a case where the computer accurately called acute mi with RBBB.PT HAD PROX RCA LESION.where can i send you the powerpoint slides i made for you to post.hugh stephenson
Hugh – Sounds like an awesome presentation!You can send the slides to ems12lead@gmail.com. Alternatively, you can upload the PowerPoint presentation to http://www.slideshare.net and send me the embed code.Thanks for reading!Tom