A 76 y/o male presents c/o chest pain and SOB. He has a previous history of a left bundle branch block. His EKG is attached.
Q1. What does the EKG show?
Q2. What is the correct management?
A1. Left Bundle Branch Block with Sgarbossa’s criteria for STEMI (concordant ST elevations V5, V6 and discordant >5mm ST elevations V1-V3)
A2. Emergent cath (treat like a STEMI)
Left bundle branch block classically masks EKG findings of acute STEMI. Sgarbossa et al devised criteria to diagnose STEMI in the presence of a LBBB. A score of 3 indicates an accurate diagnosis of STEMI with 90% specificity.
(Sgarbossa et al. Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block. NEJM 1996;34:481-7.)