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Related Subjects: |Atherosclerosis |Ischaemic heart disease |Assessing Chest Pain |ACS - General |ACS - STEMI |ACS - NSTEMI |ACS - GRACE Score |ACS - ECG Changes |ACS -Cardiac Troponins |ACS - Post MI arrhythmias |ACS: Right Ventricular Infarction |ACS: Sgarbossa Criteria
The Sgarbossa Criteria are a set of ECG findings used to diagnose AMI in patients with a pre-existing left bundle branch block (LBBB) or ventricular-paced rhythm. These criteria are crucial because the abnormal ventricular depolarization in LBBB can mask or mimic the ST-segment changes typically seen in myocardial infarction.
The Sgarbossa Criteria consist of three ECG findings, each with a specific point value. The total score helps determine the likelihood of an acute myocardial infarction.
Criterion | Description | Points |
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Concordant ST-Segment Elevation | ST-segment elevation of ≥ 1 mm in any lead with a positive QRS complex (concordant with the QRS). | 5 points |
Concordant ST-Segment Depression | ST-segment depression of ≥ 1 mm in leads V1, V2, or V3 (with a negative QRS complex). | 3 points |
Excessively Discordant ST-Segment Elevation | ST-segment elevation of ≥ 5 mm in any lead with a negative QRS complex (discordant with the QRS). | 2 points |
A modified version of the Sgarbossa Criteria has been proposed, which includes: Excessively Discordant ST-Segment Elevation: This criterion is modified to consider a proportionality rule, where the ST-segment elevation is significant if it is ≥ 25% of the preceding S-wave depth. This modification improves the sensitivity of the criteria.
The Sgarbossa Criteria are particularly useful in the emergency setting when rapid diagnosis of myocardial infarction is critical, and the presence of LBBB complicates the ECG interpretation. It helps guide decisions regarding the need for urgent reperfusion therapy in these patients.
The Sgarbossa Criteria are an essential tool for diagnosing MI in patients with LBBB. Understanding and applying these criteria in clinical practice can significantly impact patient outcomes, especially in emergency situations where timely intervention is crucial.