STEMI & LBBB (Sgarbossa/Smith Criteria)

Detection of an STEMI in patients with an underlying LBBB can be challenging but it is not impossible - Anand Swaminathan MD

STEMI & LBBB (Sgarbossa/Smith Criteria)
STEMI & LBBB (Sgarbossa/Smith Criteria)

image by: Alzamani Mohammad Idrose

HWN Suggests

STEMI in the Presence of LBBB

The diagnosis of STEMI in LBBB is dependent on the “Rule of Appropriate Discordance,” which means that, in normal LBBB (without MI), the ST segment (and usually T-wave) are in the opposite direction (discordant to) the majority of the QRS. “Concordance” (ST segment in the same direction as the QRS) is abnormal and indicates STEMI. Sgarbossa and others have found high specificity of an ST segment that is concordant to the QRS.

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 STEMI in the Presence of LBBB

The diagnosis of STEMI in the presence of left bundle branch block has been problematic for years. Until recently, the guidelines for management of Acute MI recommended cath lab activation for patients with chest pain and new LBBB. This was a nearly useless recommendation, as it turns out that only approximately 2-4% of patients who present to the ED with chest pain and new LBBB have acute coronary occlusion, and this is no different than patients who present with old LBBB

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