How to find STEMI in Paced Rhythm (feat. Dr Sgarbossa)

How can we find a STEMI in patients with a ventricular paced rhythm? Can we use the Sgarbossa Criteria?
Hear Elena Sgarbossa, Jonathan Ilicki and Alex Szeps delve into how we best assess these patients in this plenary ECG masterclass from Swedish Emergency Talks 2019.
ADDENDUM: Please note that the Smith-modified Sgarbossa Criteria have recently been shown to have superior sensitivity and specificity to the original criteria. It wasn't included in the presentation as it's quite tricky to fit the phrase "Smith-modified Sgarbossa Criteria" into a song...
Thank you to:
- Alex Szeps (Spotify: open.spotify.com/artist/6lcoh... )
- Elena Sgarbossa - for cutting-edge research, participation and support
- Therese Djärv, Jonas Willmer - for serendipitously helpful questions
- Emil Boström, Niclas Lewisson, Lesli Liljegren, Johanna Berg, Lina Holmberg, Patrik Nilsson - recording what most likely is the internet's best song on ventricular paced rhythms
- A kind patient that gave consent to us to write a case report and spread the knowledge about how to identify ACS in ventricular paced rhythms
- Swedish Emergency Talks: sweets.nu/en/
[References]
- Sgarbossa EB, Pinski SL, Gates KB, Wagner GS. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. GUSTO-I investigators. Am J Cardiol. 1996 Feb 15;77(5):423-4.
- Macfarlane PW, Browne D, Devine B, Clark E, Miller E, Seyal J, Hampton D. Modification of ACC/ESC criteria for acute myocardial infarction. J Electrocardiol. 2004;37 Suppl:98-103.
- Maloy KR, Bhat R, Davis J, Reed K, Morrissey R. Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers. West J Emerg Med. 2010 Sep;11(4):354-7.
- Freitas P, Santos MB, Faria M, Rodrigues G, Vale N, Teles RC, Almeida M, Mendes M. JECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply? Electrocardiol. 2016 Sep-Oct;49(5):744-8.
- Bertel N, Witassek F, Puhan M, Erne P, Rickli H, Naegeli B, Pedrazzini G, Stauffer JC, Radovanovic D. Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm. Int J Cardiol. 2017 Mar 1;230:604-609.
- Herweg B, Marcus MB, Barold SS. Diagnosis of myocardial infarction and ischemia in the setting of bundle branch block and cardiac pacing.Herzschrittmacherther Elektrophysiol. 2016 Sep;27(3):307-22.
- Ilicki J, Bruchfeld S, Kolsrud B, Böhm F, Djärv T. Sgarbossa criteria used to identify cardiac ischemia in patient with ventricular paced rhythm. J Electrocardiol. 2018 Sep - Oct;51(5):830-832.
- Jothieswaran A, Body R. BET 2: Diagnosing acute myocardial infarction in the presence of ventricular pacing: can Sgarbossa criteria help? Emerg Med J. 2016 Sep;33(9):672-3.
- Meyers HP, Limkakeng AT Jr, Jaffa EJ, Patel A, Theiling BJ, Rezaie SR, Stewart T, Zhuang C, Pera VK, Smith SW. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015 Dec;170(6):1255-64. doi: 10.1016/j.ahj.2015.09.005. Epub 2015 Sep 24.

[@ahmedmedtech]

very very very fancy ; round of applause for the singing, thoroughly enjoyed

[@ebmdoctor]

Thank you! Happy you liked it : )

[@LATSRN]

Great find… entertainment to learn from! 😂

[@ahmedmedtech]

show me something on his ECG HAHAHAHAHAHAHAHAHHAAHAHAHAHAHAH! well staged have to be honest