ECG Quest > Ischemia > ST changes with LBBB > Positive Sgarbossa criteria

Positive Sgarbossa criteria

The Sgarbossa criteria help to diagnose acute infarction in the presence of a wide QRS (left bundle branch block or ventricular paced rhythm). The original Sgarbossa Criteria have been modified to improve the accuracy.

Modified Sgarbossa Criteria

  • ≥ 1 lead with ≥1 mm of concordant ST elevation
  • ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
  • ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.
See also: ST changes with LBBB

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In the ECGquest archives, this ECG has been tagged with: - Concordant ST depression in V1-V3 Excessive discordant ST elevation Atrial pacemaker Ventricular pacemaker Acute Inferior MI Acute Lateral MI Acute Posterior MI Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm?

This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.

This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Excessive discordant ST elevation Wide QRS Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Following Criteria Exactly, even the Modified Sgarbossa Criteria, Can Be Deadly – ECG 2

This ECG is from a man in his 70s who presented with epigastric pain.

This ECG shows These discordant ST changes are excessive and do meet Modified-Sgarbossa criteria. This was missed. The patient went into VF shortly after and died.

In the ECGquest archives, this ECG has been tagged with: - Tachycardia Wide QRS Change in rhythm Wide complex tachycardia Bifascicular block LAFB RBBB Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
What is this rhythm? And what else does it show?

This ECG is from a man in his 60s who presented with abdominal pain dyspnoea and altered level of consciousness, in shock.

This ECG shows wide complex tachycardia with concordant ST elevation in V4-6, due to LAD occlusion. The rhythm was likely sinus tachycardia with RBBB and then LAFB mid way through the trace.

In the ECGquest archives, this ECG has been tagged with: - Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest Pain and RBBB. What do you think?

This ECG is from an elderly woman who presented with 25 min of chest pain after working out.

This ECG shows new RBBB and LAFB with ST elevation in V1 caused by an occlusion of septal perforator.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Excessive discordant ST elevation LBBB Acute Inferior MI Positive Sgarbossa criteria 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
A 60-something year old man with chest pain and a wide QRS

This ECG is from a man in his 60s who presented with chest pain for several hours on a background of prior coronary artery disease and hypertension.

This ECG shows LBBB with excessively discordant ST elevation in inferior leads with reciprocal changes in I and aVL. The cause was a RCA in-stent restenosis.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Extreme Axis Regular Concordant ST depression in V1-V3 Excessive discordant ST elevation Wide QRS Ventricular pacemaker Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.

This ECG is from an elderly woman who presented with chest pain on a background of a normal angiogram 3 months prior.

This ECG shows ventricular paced rhythm (likely biventricular) with concordant ST depression in III, aVF and V3. There is excessive discordant ST elevation in I and aVL. The cause was an acute left main occlusion due to suspected embolism.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Pacemaker spikes Ventricular pacemaker Acute Posterior MI Positive Sgarbossa criteria 12-Lead LITFL Dr Edward Burns CC-BY-NC-SA
Positive Sgarbossa criteria in a patient with a ventricular paced rhythm

This ECG is from a patient of unknown age.

This ECG shows concordant ST depression in V2-5 and prominent T waves in a ventricular paced rhythm. The cause was a posterior infarction.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation LBBB Acute Lateral MI Positive Sgarbossa criteria 12-Lead LITFL Dr Edward Burns CC-BY-NC-SA
Positive Sgarbossa criteria in a patient with LBBB and troponin-positive myocardial infarction

This ECG is from a patient of unknown age who presented with chest pain.

This ECG shows LBBB with 1mm concordant ST elevation in aVL. There is also a pathological Q wave in I and concordant ST depression in III and aVF. The most likely cause was a high lateral infarction.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Incorrect Machine Interpretation Concordant ST elevation Excessive discordant ST elevation Sinus tachycardia LBBB Acute Anterior MI Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Shouldn’t need Modified Sgarbossa rule for cath lab here, but it does make the diagnosis certain!

This ECG is from a woman in her 70s with 30 min of chest pain on a background of MI with stents a month ago.

This ECG shows sinus tachycardia with LBBB and concordant ST elevation in I and aVL. Excessively discordant ST elevation in V3 and V4. The cause was most likely a proximal LAD occlusion.