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A 72 yo patient presents with chest pain. He is known to have ischaemic heart disease, hypercholesterolaemia and hypertension.

His old ECG shows a left bundle branch block.

His ecg today, is shown below. What does it show? Are you concerned for ischaemia?


What is the Diagnosis?

Is this an acute myocardial Infarction (AMI)?

We can apply Sgarbossa’s Criteria to diagnose an AMI in the presence of a left bundle branch block, or when there is a paced rhythm.

What are the Sgarbossa’s Criteria?

Sgarbossa Criteria to diagnose a STEMI in LBBB:

1.STE > 1mm concordant with the QRS complex.
2.STD > 1mm in leads V1, or V2 or V3
STE or STD which is > 25% of the discordant QRS


This patient does satisfy two of the three criteria, ie., there is discordant ST elevation of >25% of QRS in V2 and V3 and there is concordant STE in V4 and V5.


Dr Peter Kas

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