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Thursday, July 29, 2010

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




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2 comments:

  1. Adam Thompson, EMT-PJuly 29, 2010 at 11:34 AM

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

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  2. Tom BJuly 29, 2010 at 11:44 AM

    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.

    Tom

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