Tag Archives: left bundle branch block

58 year old female CC: Chest pain – Conclusion

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Here’s the conclusion to the 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 Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block. Keep […]

79 year old male CC: Shortness of breath

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Here’s another interesting case submitted by Geoff Dayne. 79 y/o male c/o non-provoked SOB without CP. Patient was found sitting upright, tripodding, 1 word dyspnea. Lung sounds: extremely decreased tidal volume. EMS crew was unable to tell if there was rales or wheezing. Past medical history: HTN, dyslipidemia, CHF, pacemaker (recently implanted within a week […]

Discordant ST-Segment Elevation in LBBB or Paced Rhythm

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If you’ve been following the Prehospital 12-Lead ECG blog for a while, you know that I’m advocate of using Sgarbossa’s criteria to help identify acute STEMI in the presence of left bundle branch block (LBBB) or paced rhythm. According the Sgarbossa’s original criteria, 5 mm of discordant ST-segment elevation is required to identify AMI in […]

"New" LBBB – What's the big deal?

In the January 2010 EMCast at EMedHome.com, Amal Mattu MD reviews Chang AM, Shofer FS, Tabas JA, et al. Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic ED patients. Am J Emerg Med 2009;27:916-921. His comments confirm what I have suspected for a long time with regard to LBBB in […]

Sgarbossa's Criteria – New Graphic

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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 […]

The problem of ST segment elevation

This post has been updated and moved here: http://www.ecgmedicaltraining.com/st-segment-elevation-beyond-false-positives/  

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