cardiology
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Rescooped by Soni Narayan from Medicine update
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Diagnosing MI in setting of Left Bundle Branch Block

Diagnosing MI in setting of Left Bundle Branch Block | cardiology | Scoop.it

myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult. The 2004 STEMI guideline recommended emergent reperfusion therapy to patients with suspected ischemia and new or presumably new LBBB. These recommendations have led to frequent false catheterization laboratory activation and inappropriate fibrinolytic therapy because most patients with suspected ischemia and new or presumably new LBBB do not have acute coronary artery occlusion on angiography. The new 2013 STEMI guideline makes a drastic change by removing previous recommendations. Therefore, patients with suspected ischemia and new or presumably new LBBB would no longer be treated as STEMI equivalent. The new guideline fails to recognize that some patients with suspected ischemia and LBBB do have STEMI, and denying reperfusion therapy could be fatal. The Sgarbossa electrocardiography criteria are the most validated tool to aid in the diagnosis of STEMI in the presence of LBBB. A Sgarbossa score of ≥3 has a superb specificity (98%) and positive predictive value for acute myocardial infarction and angiography-confirmed acute coronary occlusion. Thus, we propose a diagnosis and triage algorithm incorporating the Sgarbossa criteria to quickly and accurately identify, among patients presenting with chest pain and new or presumably new LBBB, those with acute coronary artery occlusion. This is a high-risk population in which reperfusion therapy would be denied by the 2013 STEMI guideline. we discuss sagarbossa and other criteria in this setting


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Rescooped by Soni Narayan from Medicine update
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New STEMI guidelines

New STEMI guidelines | cardiology | Scoop.it

2013 guidelines makes these changes, which we've covered before, to the identification of STEMI: 1. "New or presumed new" Left Bundle Branch Block is no longer an indication for a STEMI. Providers should use Sgarbossa's criteria to diagnose STEMI in the presence of LBBB . ( we're going to go ahead and add that our readers should take this one step further and utilize Smith's modification to Sgarbossa's criteria .) 2. Isolated ST-depression in V1-V4 is an indication of a posterior STEMI. 3. Widespread ST-depression with ST-elevation in aVR is an indication of proximal LAD or LMCA occlusion. (the evidence points more towards this being an indication of 3-vessel disease or near occlusion of the LAD/LMCA.) 4. Hyperacute T-waves , e.g. de Winter ST/T-wave changes, are an early indicator of a STEMI.


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