A man in his 70s with acute chest pain and paced rhythm.

Sent by Pete McKenna M.D.  Edits by Meyers and SmithA man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of  acute chest pain.Triage ECG:What do you think?This is diagnostic of proximal LAD occlusion.  This is a huge anterolateral OMI.  Deadly.  I cannot be anything else.Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. Queen of Hearts interpretation:The cardiologist initially was not convinced, stating the ECG was not diagnostic or could not be diagnostic because it was paced. The ED physician attempted to explain the modified Sgarbossa criteria, but without success. (This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). ===========================================Modified Sgarbossa Criteria Refresher! Skip if you don ' t need this.===========================================Here is a visual comparison of the original and modified Sgarbossa Criteria (each has 3 criteria, and only one criterion differs between them: criterion 3 is absolute millimeters in the original, versus proportional in the modified version)Validation in LBBB: Meyers HP. &...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs