One Hammad 🏴☠️ @HDforOneHD
Internal Medicine Resident| Ecg Enthusiast | Sky is the limit | MBBS 🇸🇩 | SCFHS 🇸🇦| USMEL STEP 1&2, ECFMG certified 🇺🇸 | Ireland Medical Council 🇮🇪 Joined August 2025-
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@ACCinTouch @escardio @HRS_CaseReports 3rd lesson:
🧵3/ Identifying MI in ECG with LBBB or ventricular-paced rhythm🫀. Identifying MI when the ECG shows LBBB or is ventricular-paced is difficult because the ECG already shows abnormal changes that could indicate MI in a normal ECG. In that case, we use the Sgarbossa Criteria🧐.
@ACCinTouch @escardio @HRS_CaseReports x.com/hdforonehd/sta…
2/ Posterior STEMI on ECG 🫀. PT presents with typical chest pain and you think STEMI but you don’t find ST elevation, why🤔? Posterior MI can’t be visualized by the standard 12-lead ECG because it reflects the anterior wall, therefore the changes will be inverted upside down.🙃
👏 Modified Sgarbossa Criteria: ➡️ Sgarbossa 1/Cordorant ST elevation > 1 mm in more than 1 lead. ➡️ Sgarbossa 2/Cordorant ST depression > 1 mm in V1-V3. ➡️ Sgarbossa 3/Excessive discordant ST elevation >1 lead, in any lead,> 1 mm, more than 25% of the preceding S wave in.
So what is Sgarbossa Criteria 🤔? The criteria was first developed by Elena B Sgarbossa in 1996 and then further modified in 2012 for better accuracy. I won’t go in details about the differences between them. I will focus on the modified Sgarbossa Criteria and how to use it.
🧵3/ Identifying MI in ECG with LBBB or ventricular-paced rhythm🫀. Identifying MI when the ECG shows LBBB or is ventricular-paced is difficult because the ECG already shows abnormal changes that could indicate MI in a normal ECG. In that case, we use the Sgarbossa Criteria🧐.
@Frances98392343 Jubctional escape rhythm, pvcs, incomplete LBBB.
@FibrilloFlutter @TrackYourHeart @KostekMilan @Frances98392343 @ecgandrhythmRoe @Dr_Shiv_kumar_ @makkyecg @koggelnoggel @The_Nanashi_O @capuzzi_luciano @Charanreddy246 And what is his presentation?
@FibrilloFlutter @TrackYourHeart @KostekMilan @Frances98392343 @ecgandrhythmRoe @Dr_Shiv_kumar_ @makkyecg @koggelnoggel @The_Nanashi_O @capuzzi_luciano @Charanreddy246 Normal axis, pvcs couplet, SR, RBBB alternating with LBBB? Interesting ecg. Do you have the rhythm strip?
@Frances98392343 @FibrilloFlutter @KostekMilan @ecgandrhythmRoe @Dr_Shiv_kumar_ @TrackYourHeart @makkyecg @koggelnoggel @The_Nanashi_O @capuzzi_luciano @Charanreddy246 But you are correct, he is tachy in the last beats.
@Frances98392343 @FibrilloFlutter @KostekMilan @ecgandrhythmRoe @Dr_Shiv_kumar_ @TrackYourHeart @makkyecg @koggelnoggel @The_Nanashi_O @capuzzi_luciano @Charanreddy246 Do you mean beats 5-8 are NSVT? They look like RBBB.
@KKpvc44 @mainichiECG I don’t think it is PAC because of the abnormal P wave shape. I think PJC more likely to explain it. These P waves aren’t sinus nor atrial origin.
@IhabFathiSulima SR with pvc bigeminy.
@sohrab1104 @Frances98392343 @Ecgloverr @ecgandrhythmRoe @AbdulazizM2669 @FibrilloFlutter @KostekMilan ST depressions are 2nd changes due to tachycardia vs digoxin effects 🤔🤔
@sohrab1104 @Frances98392343 @Ecgloverr @ecgandrhythmRoe @AbdulazizM2669 @FibrilloFlutter @KostekMilan SR, PVCs, Sinus tachycardia with LBBB.
@JuanCaic4 On 2nd thought, I think atrial flutter 2:1 mostly clear in precordial leads.
@JuanCaic4 I would say AF despite having clear waves before QRS complex, I can’t explain them as AFL with variable block or AF.
@EM_RESUS Nice case. I encountered similar pt who presented to ED with dizziness and fall down. Upon waking up, we questioned what happened before the onset of dizziness, he replied CHEST PAIN. Ecg show anteroir stemi, borderline bp. Taken to cath lab after doing CT brain.
@0music6 What a tricky case!! I can’t think of how the neurologist and cardiologist will decide on the PCI and anticoagulant use.
@DialedMedics Accelerated junctional rhythm
Munira @munira_sulii
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