A 65-year-old man with hypertension presents to the emergency department with 4 hours of chest pain. ECG shows left bundle branch block with 2 mm concordant ST elevation in V5 and V6 and 3 mm discordant ST elevation in V1. Using the modified Sgarbossa criteria, what is the appropriate interpretation?

• A Normal ST segments in the presence of LBBB, no further action needed
• B Nonspecific intraventricular conduction delay
• C Left ventricular hypertrophy with secondary ST changes
• D Acute STEMI equivalent, activate catheterization laboratory ✓

Explanation

The modified Sgarbossa criteria identify STEMI in LBBB using concordant ST elevation of at least 1 mm, concordant ST depression of at least 1 mm in V1-V3, or excessively discordant ST elevation exceeding 25 percent of the S-wave depth. Concordant ST elevation in V5-V6 meets the criteria and indicates urgent reperfusion is needed.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.