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Sgarbossa criteria

Nana Sefa, Kelly N Sawyer
BACKGROUND: As the incidence of left bundle branch blocks (LBBBs) and paced-rhythms electrocardiograms (ECGs) increase in the aging global population, the need for rapid and accurate diagnosis of ST-elevation myocardial infarction (STEMI) or STEMI equivalents in patients with these rhythms becomes more imperative. The Sgarbossa and Smith-modified Sgarbossa criteria have been documented to enhance the diagnosis of STEMI in the setting of LBBBs. However, there is a growing body of literature that suggests that these criteria can also be applied for the diagnosis of STEMI in patients with paced rhythms...
September 8, 2016: Journal of Emergency Medicine
Arunan Jothieswaran, Richard Body
The Sgarbossa criteria can be used to identify patients who have acute myocardial infarction (AMI) in the presence of left bundle branch block, which obscures the usual changes associated with ST elevation myocardial infarction. Patients with ventricular paced rhythm have ECG changes with similar morphology to left bundle branch block. A short-cut systematic review was carried out to establish whether the Sgarbossa criteria can accurately diagnose AMI in the presence of ventricular paced rhythm. Three studies were directly relevant to the question...
September 2016: Emergency Medicine Journal: EMJ
Pedro Freitas, Miguel Borges Santos, Mariana Faria, Gustavo Rodrigues, Nélson Vale, Rui Campante Teles, Manuel Almeida, Miguel Mendes
BACKGROUND/PURPOSE: In patients with right ventricular pacing, the ECG shows a left bundle branch block (LBBB) pattern. There are several criteria to diagnose ST-elevation myocardial infarction (STEMI) in patients with LBBB. The aim of this study was to validate and compare Sgarbossa's with two new scores - Selvester's and Smith's - in this context. METHODS: We identified pacemaker patients submitted to coronary angiography due to acute coronary syndrome. ECGs were analyzed by 2 blinded cardiologists...
September 2016: Journal of Electrocardiology
B Herweg, M B Marcus, S S Barold
The diagnosis of myocardial infarction (MI) in the presence of left bundle branch block (LBBB) or during ventricular pacing (VP) is challenging because of inherent changes in the sequence of ventricular depolarization and repolarization associated with both conditions. Although LBBB and right ventricular (RV) pacing may both produce abnormalities in the ECG, it is often possible to diagnose an acute MI (AMI) or an old MI based on selected morphologic changes. Primary ST-segment changes scoring 3 points or greater according to the Sgarbossa criteria are highly predictive of an AMI in patients with LBBB or RV pacing...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
H Pendell Meyers, Elias Jaffa, Stephen W Smith, Weiying Drake, Alexander T Limkakeng
BACKGROUND: T-wave morphology in the setting of left bundle branch block (LBBB) has been proposed as an indicator of myocardial ischemia. OBJECTIVES: We sought to identify T-wave morphology findings in patients with LBBB that predict non-ST-segment elevation myocardial infarction (NSTEMI). We hypothesized that two or more contiguous leads with concordant T waves would be predictive of NSTEMI. METHODS: This was a retrospective cohort study performed by chart review in a tertiary care center emergency department...
September 2016: Journal of Emergency Medicine
Debraj Das, Brent M McGrath
No abstract text is available yet for this article.
April 18, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Kenneth W Dodd, Kendra D Elm, Stephen W Smith
BACKGROUND: The modified Sgarbossa criteria have been validated as a rule for diagnosis of acute coronary occlusion (ACO) in left bundle branch block (LBBB). However, no analysis has been done on differences in the QRS complex, T-wave, or ST-segment concordance of < 1 mm in the derivation or validation studies. Furthermore, there was no comparison of patients with acute myocardial infarction (AMI) but without ACO (i.e., non-ST-elevation myocardial infarction [non-STEMI]) to patients with ACO or without AMI (no MI)...
July 2016: Journal of Emergency Medicine
G Ciliberti, M Del Pinto, F Notaristefano, G Zingarini, G Ambrosio, C Cavallini
Identification of acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) remains challenging. European guidelines recommend prompt reperfusion therapy in patients with suspected ongoing myocardial ischemia and new or presumably new LBBB, whereas AHA/ACC guidelines state that LBBB should not be considered diagnostic of AMI in isolation. Sgarbossa criteria and their recent modified version with the introduction of ST/S ratio can be helpful in this setting. A clinical-instrumental algorithm to manage suspected AMI in the presence of LBBB has been recently proposed...
July 2016: Journal of Electrocardiology
H Pendell Meyers, Alexander T Limkakeng, Elias J Jaffa, Anjni Patel, B Jason Theiling, Salim R Rezaie, Todd Stewart, Cassandra Zhuang, Vijaya K Pera, Stephen W Smith
BACKGROUND: The modified Sgarbossa criteria were proposed in a derivation study to be superior to the original criteria for diagnosing acute coronary occlusion (ACO) in left bundle branch block (LBBB). The new rule replaces the third criterion (5 mm of excessively discordant ST elevation [STE]) with a proportion (at least 1 mm STE and STE/S wave ≤-0.25). We sought to validate the modified criteria. METHODS: This retrospective case-control study was performed by chart review in 2 tertiary care center emergency departments (EDs) and 1 regional referral center...
December 2015: American Heart Journal
M Ostojić, Marina M Ostojić, Tatjana S Potpara, Marija M Polovina, Mladen M Ostojić, Miodrag C Ostojić
INTRODUCTION: Electrocardiographic (ECG) diagnosis of acute myocardial infarction (AMI) in patients with paced rhythm is difficult. Sgarbossa's criteria represent helpful diagnostic ECG tool. CASE REPORT: A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarbossa's criterion for AMI in patients with dual pacemakers (ST-segment elevation of 5 mn in the presence of the negative QRS complex)...
September 2015: Vojnosanitetski Pregled. Military-medical and Pharmaceutical Review
Igor Ivanov, Sonja Bugarski, Jadranka Dejanović, Anastazija Stojsić Milosavljević, Jasna Radisić Bosić, Bojan Vujin
INTRODUCTION: Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. LITERATURE REVIEW: Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations...
November 2013: Medicinski Pregled
Qiangjun Cai, Nilay Mehta, Elena B Sgarbossa, Sergio L Pinski, Galen S Wagner, Robert M Califf, Alejandro Barbagelata
Prompt and accurate identification of ST-elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult. The 2004 STEMI guideline recommended emergent reperfusion therapy to patients with suspected ischemia and new or presumably new LBBB. These recommendations have led to frequent false catheterization laboratory activation and inappropriate fibrinolytic therapy because most patients with suspected ischemia and new or presumably new LBBB do not have acute coronary artery occlusion on angiography...
September 2013: American Heart Journal
Richard E Gregg, Eric D Helfenbein, Saeed Babaeizadeh
BACKGROUND: ECG detection of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) is challenging due to ST deviation from the altered conduction. The purpose of this study was to introduce a new algorithm for STEMI detection in LBBB and compare the performance to three existing algorithms. METHODS: Source data of the study group (143 with acute MI and 239 controls) comes from multiple sources. ECGs were selected by computer interpretation of LBBB...
November 2013: Journal of Electrocardiology
Stephen W Smith, Kenneth W Dodd, Timothy D Henry, David M Dvorak, Lesly A Pearce
STUDY OBJECTIVE: Sgarbossa's rule, proposed for the diagnosis of acute myocardial infarction in the presence of left bundle branch block, has had suboptimal diagnostic utility. We hypothesize that a revised rule, in which the third Sgarbossa component (excessively discordant ST-segment elevation as defined by ≥5 mm of ST-segment elevation in the setting of a negative QRS) is replaced by one defined proportionally by ST-segment elevation to S-wave depth (ST/S ratio), will have better diagnostic utility for ST-segment elevation myocardial infarction (STEMI) equivalent, using documented coronary occlusion on angiography as reference standard...
December 2012: Annals of Emergency Medicine
Ross McMahon, Way Siow, Ravinay Bhindi, Soon Y Soo Hoo, Gemma Figtree, Peter S Hansen, Gregory I C Nelson, Helge H Rasmussen, Michael R Ward
BACKGROUND: The Sgarbossa score has been used to identify acute myocardial infarction on ECG in the presence of LBBB but has relied on elevated CK-MB for validation rather than angiographic evidence of vessel occlusion. METHODS: We determined (a) the presence or absence of Sgarbossa criteria with concordant (S-con) or discordant (S-dis) ST changes, (b) the presence of acute coronary occlusion or likely recent occlusion on angiography and (c) the biochemical evidence of myocardial infarction (Troponin T >0...
August 20, 2013: International Journal of Cardiology
Sonia Jain, Henry T Ting, Malcolm Bell, Christine M Bjerke, Ryan J Lennon, Bernard J Gersh, Charanjit S Rihal, Abhiram Prasad
The clinical utility of new or "presumably new" left bundle branch block (LBBB) as an electrocardiographic criterion equivalent to ST-segment elevation myocardial infarction in contemporary practice is not well established. The aim of this study was to investigate the hypothesis that new or presumably new LBBB in symptomatic patients frequently leads to an overdiagnosis of acute myocardial infarction (AMI). A retrospective analysis of data from consecutive patients in the Mayo Clinic's ST-segment elevation myocardial infarction network from July 2004 to August 2009 was conducted among 892 patients, 36 (4%) of whom had new LBBB...
April 15, 2011: American Journal of Cardiology
Neha Alang, Jaya Bathina, Mark Kranis, Dimitrios Angelis
Diagnosis of acute ST-elevation myocardial infarction in the presence of left bundle branch block is difficult. present a case of acute myocardial infarction with LBBB diagnosed and treated using the Sgarbossa criteria.
March 2010: Indian Heart Journal
Kevin R Maloy, Rahul Bhat, Jonathan Davis, Kevin Reed, Richard Morrissey
OBJECTIVE: In 1996 Sgarbossa reviewed 17 ventricular-paced electrocardiograms (ECGs) in acute myocardial infarction (AMI) for signs of ischemia. Several characteristics of the paced ECG were predictive of AMI. We sought to evaluate the criteria in ventricular-paced ECGs in an emergency department (ED) cohort. METHODS: Ventricular-paced ECGs in patients with elevated cardiac markers within 12 hours of the ED ECG and a diagnosis of AMI were identified retrospectively (n=57) and compared with a control group of patients with ventricular-paced ECGs and negative cardiac markers (n=99)...
September 2010: Western Journal of Emergency Medicine
Beata Wozakowska-Kapłon, Kamilla Wesołowska, Dawid Bakowski, Radosław Bartkowiak
Venticular paced rhythm makes diagnosis of acute myocardial infarction difficult. We present a case of a 77-year-old woman with cardiac DDD pacemaker, suffering from diabetes, arterial hypertension and renal insufficiency. She was admitted to hospital due to heavy chest pain, radiated to neck and jaw and shortness of breath. The electrocardiogram recorded on admission showed ventricular paced rhythm and ST segment elevation > 0.5 mV, which fulfilled Sgarbossa's criteria for indetermined acute coronary syndrome in a patient with pacemaker...
May 2009: Kardiologia Polska
Andrew T Kwa, John Kao, Ezra A Amsterdam
We describe the case of a 73 year-old woman presenting with symptoms compatible with myocardial ischemia/injury and left bundle branch block in whom the electrocardiogram fulfilled Sgarbossa criteria for ST-elevation myocardial infarction. Coronary angiography revealed an acute coronary occlusion and she was successfully revascularized. The value and limitations of the Sgarbossa criteria are discussed and the importance of considering ST-elevation myocardial infarction in patients presenting with chest discomfort and new left bundle branch block is emphasized...
June 2009: Critical Pathways in Cardiology
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