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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