Modified Sgarbossa Criteria - Diagnostic Checklist for diagnosing MI in LBBB or Pacemaker
1) Identify LBBB or Pacemaker
LBBB: QRS >120ms, Dominant S wave in V1 (deep S waves V1-V3), Broad Monophasic R wave in l, V5-V6, ("M-shaped R"), Left axis deviation
Pacemaker:
- Paced: Preceded by vertical 2ms spike
- Fusion: odd QRS from native + PM beat fusing
- Capture: Narrow, different QRS from native beat conducted
2) LBBB or PM? Should see "Appropriate Discordance" = ST and T waves in opposite direction to QRS main vector
3) Implement Modified Sgarbossa Criteria - Suspect STEMI if any of A-C:
a) Concordant STE > 1 mm in any lead
b) Concordant STD > 1 mm in leads V1-V3
c) STE / S wave > 25% in any lead
- Dr. Sarah Foohey @SarahFoohey
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