Hereâ€™s the conclusion to theÂ 58 year old female with chest pain and left bundle branch block.
To refresh your memory here is the 12-lead ECG.
And for those of you who requested lead V4R.
This ECG meets all 3 of Sgarbossaâ€™s criteria to identify acute STEMI in the presence of left bundle branch block.
Keep in mind, it only has to meet one criterion in one lead!
(Please note: One criterion has been modified from its original form. Instead of discordant ST-elevation > 5 mm we are looking for discordant ST-elevation > 0.2 the depth of the S-wave. This is known as the ST/QRS ratio. Credit to Dr. Smith ofÂ Dr. Smithâ€™s ECG Blog.)
Angiography revealed 100% occlusion of the LCX and 99% occlusion of the RCA.
Thanks to everyone who commented on the case!