Left Bundle Branch Blocks + AMI

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EKGotW, LBBB

or, WTF am I Looking at?

EKG#1

1. What’s the morphology?2. Do you activate the cath-lab or not?

1. What’s the morphology?

2. Do you activate the cath-lab or not?

EKG #2

1. Alright, smarty-pants, how about this one?? Cath-lab, ya or na?2. Feel free to interpret any other strange abnormalities in this EKG, but the real question is if this person is having an AMI or not.

1. Alright, smarty-pants, how about this one?? Cath-lab, ya or na?

2. Feel free to interpret any other strange abnormalities in this EKG, but the real question is if this person is having an AMI or not.

EKGotW #7

 

Left Bundle Branch Block
&
Modified Sgarbossa Criteria

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PART ONE: What’s a LBBB? (Left Bundle Branch Block, not a lanky-bashful-big-boy)

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PART TWO: How do I find it?

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PART THREE: How do I diagnose a MI in the setting of LBBB?

 

Modified Sgarbossa Criteria

91% Sensitive, 90% Specific

 

There are only three criteria.

If any of them are present, call the cath lab.

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PART FOUR: Answers

 

EKG #1

Sinus, LBBB, no ischemic changes

- QRS and ST are all appropriately discordant.- There is no (1) concordant ST elevation, (2) concordant ST depression in V1-3, or (3) ST elevation that is more than a quarter of the S wave before it.

- QRS and ST are all appropriately discordant.

- There is no (1) concordant ST elevation, (2) concordant ST depression in V1-3, or (3) ST elevation that is more than a quarter of the S wave before it.

EKG #2

Ventricular paced rhythm with LBBB morphology, meets Modified Sgarbossa Criteria

Rhythm is tricky and I’m not positive on this one. It may be complete heart block, but the P waves are irregular, though monomorphic. This makes me think complete heart block with compensatory pauses vs sick-sinus. Email if you have something a little more concrete.

- V2 & V3 have concordant ST depression. (V1 borderline.)- This, plus a clinical picture of ACS, is enough to call the cath lab.

- V2 & V3 have concordant ST depression. (V1 borderline.)

- This, plus a clinical picture of ACS, is enough to call the cath lab.