ToolsCalculators
Modified Sgarbossa's Criteria for MI in Left Bundle Branch Block
Identifies acute coronary occlusion in the presence of left bundle branch block (or ventricular paced rhythm).
Modified Sgarbossa's Criteria for MI in Left Bundle Branch Block
Maximum concordant ST elevation (any lead, QRS positive)
mm
Maximum concordant ST depression in leads V1-V3
mm
ST elevation in the lead with the most excessively discordant ST/S ratio
mm
S-wave depth in that same lead (magnitude)
mm
Complete the fields above to see the result.
When to use
- Evaluating for acute coronary occlusion in a patient with chest pain and left bundle branch block or a ventricular-paced rhythm, where standard STEMI criteria cannot be applied.
Formula
Positive if any one of: (1) concordant ST elevation >=1 mm in any lead; (2) concordant ST depression >=1 mm in V1-V3; (3) discordant ST elevation with ST/S ratio <= -0.25 (replaces the original absolute >=5 mm discordant STE criterion).
Pearls and pitfalls
- The ST/S ratio criterion is far more sensitive than the original absolute 5 mm discordant STE criterion, with similar specificity.
- Applies equally to ventricular-paced rhythms in most validation studies.