Sgarbossa revisited – MI in LBBB

25 Sep

wanted to revisit this useful tool for looking for MI’s in those hard to interpret EKGs with LBBB (left bundle branch block)

USEFUL BASICS (click through for the breakdown):

–you’re handed an EKG, and there’s a LBBB

–look for >=1mm concordant ST elevation
–look for ST depression in anterior leads (V1, V2, V3)

if you see these things, worry about an MI (>90% specific)

 

MODIFIED CRITERIA:

same as above, but also add this:

–look for discordant ST deviation

–if ST segment change is > 1/4th the amplitude of the R or S-wave, worry about an MI

 

WHAT IF ITS PACED?

–if you see discordant ST elevation >5mm in a paced rhythm, worry about an MI.

 

 

References: basics; modified; paced; picture

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