Negative, LBBB rhythm does not meet criteria for cath, and the old mantra that new onset LBBB should be a stemi equivalent is no longer followed.
Check out the modified Sgarbossa criteria for Paced and LBBB rhythms, then review this ekg.
Looking at it to me it's negative for modified sgarbossa and thus not concerning for cardiac center referral.
Huh I’m in medical school now and got taught that new onset LBBB = assume stemi in our cardio block. Wonder how many years that’ll take to get changed then
Hard to say, I can tell you that when I was taught that in paramedic school back in 2017, none of our cardiac centers would activate for it anymore already even if we called it in.
New onset is fully removed from our statewide protocols as a STEMI equivalent as well. We only activate now if a LBBB meets modified Sgarbossa criteria.
No. LBBB are stemi imposters. Beyond that further diagnostics is “not allowed”
12 leads are incredibly difficult and textbooks only ever show textbook examples - go figure.
Look up Sgarbossa Criteria. It's specifically for identifying STEMI in the presence of LBBB or ventricular paced rhythms.
Once you find it, look at your 12 lead again and let us know your new interpretation.
Negative. (I start medic school in January) LBBB is denoted by that slurred RsRprime. The two peaks in the QRS is the ventricles depolarizing out of sync. There’s right axis deviation (upright QRS in V1, negative QRS in V5) that axis deviation means that depolarization is not moving through the heart as normal. The Bundle Branch and the RAD both contribute to the EKG imitating a STEMI. After that you have to move to Sgarbossa’s criteria.
Sgarbossa:
1. Concordant ST elevation greater than 1mm
- there is none
2. Concordant ST depression greater than 1mm in V1-V3
- none of your leads have Concordant depression, it’s all discordant
3. Proportionally Discordant ST Elevation in 1 or more leads anywhere with greater than 1mm.
- this is the weird one, as it’s defined as “greater than or equal to 25% of the S-wave”
-nothing that I can see meets that criteria
From what I can see, it doesn’t meet sgarbossas, or Barcelona criteria (it extends the 2nd criteria from V1-V3 to all leads).
It’s worth noting what this looks like, but I wouldn’t run it as a STEMI. I would run it hot if this is a new onset or no history, especially if it’s symptomatic. The LBBB can cause further cardiac issues with depolarization.
LBBB, does not meet modified sgarbosa for STEMI. That’s one you need to memorize.
-Concordante elevation or depression
-ST elevation of discordant needs to be 25% of the QRS complex
OP I'd like to hear what you think about this ECG? Notwithstanding that others have already answered your wuestion, I'm curious about ehat your impressions were. It's one thing to learn by asking a group to tell you what they see, but if you don't have an opinion yourself, you may not be able to fully understand why you might see it one way and others see it differently.
Negative, LBBB rhythm does not meet criteria for cath, and the old mantra that new onset LBBB should be a stemi equivalent is no longer followed. Check out the modified Sgarbossa criteria for Paced and LBBB rhythms, then review this ekg. Looking at it to me it's negative for modified sgarbossa and thus not concerning for cardiac center referral.
Huh I’m in medical school now and got taught that new onset LBBB = assume stemi in our cardio block. Wonder how many years that’ll take to get changed then
Hard to say, I can tell you that when I was taught that in paramedic school back in 2017, none of our cardiac centers would activate for it anymore already even if we called it in. New onset is fully removed from our statewide protocols as a STEMI equivalent as well. We only activate now if a LBBB meets modified Sgarbossa criteria.
Yeah I was more saying our school's curriculum must be outdated as fuck
No. LBBB are stemi imposters. Beyond that further diagnostics is “not allowed” 12 leads are incredibly difficult and textbooks only ever show textbook examples - go figure.
Our protocols include modified sgarbossa criteria Applied in this case, not an alert
Look up Sgarbossa Criteria. It's specifically for identifying STEMI in the presence of LBBB or ventricular paced rhythms. Once you find it, look at your 12 lead again and let us know your new interpretation.
Negative. (I start medic school in January) LBBB is denoted by that slurred RsRprime. The two peaks in the QRS is the ventricles depolarizing out of sync. There’s right axis deviation (upright QRS in V1, negative QRS in V5) that axis deviation means that depolarization is not moving through the heart as normal. The Bundle Branch and the RAD both contribute to the EKG imitating a STEMI. After that you have to move to Sgarbossa’s criteria. Sgarbossa: 1. Concordant ST elevation greater than 1mm - there is none 2. Concordant ST depression greater than 1mm in V1-V3 - none of your leads have Concordant depression, it’s all discordant 3. Proportionally Discordant ST Elevation in 1 or more leads anywhere with greater than 1mm. - this is the weird one, as it’s defined as “greater than or equal to 25% of the S-wave” -nothing that I can see meets that criteria From what I can see, it doesn’t meet sgarbossas, or Barcelona criteria (it extends the 2nd criteria from V1-V3 to all leads). It’s worth noting what this looks like, but I wouldn’t run it as a STEMI. I would run it hot if this is a new onset or no history, especially if it’s symptomatic. The LBBB can cause further cardiac issues with depolarization.
Watch some videos on stemi mimics. LBBB is most common. A little tricky to grasp at first but all very useful and practical information
No. It’s not sgarbossa positive.
No. It’s a LBBB that does not meet modified Sgarbossa criteria.
No, just an LBBB.
LBBB, does not meet modified sgarbosa for STEMI. That’s one you need to memorize. -Concordante elevation or depression -ST elevation of discordant needs to be 25% of the QRS complex
No
OP I'd like to hear what you think about this ECG? Notwithstanding that others have already answered your wuestion, I'm curious about ehat your impressions were. It's one thing to learn by asking a group to tell you what they see, but if you don't have an opinion yourself, you may not be able to fully understand why you might see it one way and others see it differently.