58 year old female CC: Chest pain - Conclusion

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 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. Credit to Dr. Smith of Dr. Smith's ECG Blog.)

Angiography revealed 100% occlusion of the LCX and 99% occlusion of the RCA.

Thanks to everyone who commented on the case!

See also:

AMI in the presence of LBBB - Sgarbossa's Criteria Part I


Adam Thompson, EMT-P said...

Thanks for the case Tom. I like using the STE > 20% of preceding S-Wave rule. It is easier to teach.

Tom B said...

I agree! But it requires the use of calipers and a little arithmetic! It's not quite paramedic proof.

This rule is much more difficult when the "excessive discordance" is in the right precordial leads V1-V3.