Sgarbossa's Criteria – New Graphic

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 that meet the criteria.


These are the features we should be looking for with LBBB and ventricular paced rhythms!

See also:

80 year old male CC: Chest pain

Excessive discordance as a marker of acute STEMI in LBBB

80 year old male CC: Chest pain – Conclusion

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part I

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part II

“New” LBBB – What’s the big deal?

Discordant ST-segment elevation in LBBB or paced rhythm

Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)

62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)

58 year old female CC: Chest pain

58 year old female CC: Chest pain – Conclusion (meets all 3 of Sgarbossa’s criteria)

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
James
59 Year Old Male: Unwell
This is a ugly EKG. Wide complex irregular tachycardia around 150's. A-fib and a-flutter are possibilities. He's severely symptomatic. At this point, all treatment is same, electricity. If A fib, it may not want to "shock out" easily. This may be a case where initial cardioversion at max joules would be prudent. Pulmonary edema likely…
2015-07-01 22:00:13
Bryan
59 Year Old Male: Unwell
Calcium has little to no side effects, given the first EKG I think it is reasonable to consider it for first line treatment. Repeat EKG after 5 mins and reassess.
2015-07-01 21:14:40
Mike MacKenzie
The Trouble with Sinus Tachycardia
An absolute must read for all Medics. Great article. I am always trying to tell students to consider referring to these fast rhythms as a narrow complex tachycardia, then start looking for the cause, be it physiologic response or an electrical conduction issue. And as many have stated, I often hear that it must be…
2015-07-01 20:11:34
Josh
59 Year Old Male: Unwell
Looks like anterior lateral STEMI with BBB. Possibly LAD infarct. Positive Avr indicative of a Proximal LAD. Clear elevation to high and low lateral leads. I, AVL, V3,4,5,6. Reciprocal inferior ST Depression in II, III and AvF. Tachycardia could be secondary to hypotension, anxiety, pain or tachyarrythmia caused by hypoxic excitation. Descernable P waves, ST…
2015-07-01 16:19:15
Todd Ellingson
59 Year Old Male: Unwell
Being irregular argues against VT, though first glance it does look like that. This is likely afib with aberrancy. One could consider WPW with afib with antidromic conduction down accessory pathway, however WPW is usually dx'd when someone is younger - unlikely to be 59 and not know this. Electrolytes, especially high K, is a…
2015-07-01 16:02:58

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