Can you tell me the ECG findings in short summary
ECG Summary — Mrs K Vasantha, 74F
Machine Readings (from both ECGs):
| Parameter | Value |
|---|---|
| Heart Rate | 106–107 bpm |
| QRS Duration | 124 ms |
| QT / QTc (Baz) | 380 / 504 ms |
| PR Interval | 166 ms |
| RR / PP | 565–566 ms |
| Axis (P/QRS/T) | 58° / -27° / 95° |
Key Findings:
- Sinus Tachycardia — rate ~106 bpm
- Left Bundle Branch Block (LBBB) — QRS 124 ms with broad, notched morphology; confirmed by both ECGs
- Abnormal Left Axis Deviation — QRS axis -27°, consistent with Left Anterior Fascicular Block (LAFB) superimposed
- Incomplete Right Bundle Branch Block — noted on the first ECG (Schiller machine interpretation)
- Prolonged QTc — 504 ms (Bazett); clinically significant, warrants monitoring
- Repolarization Abnormality — secondary ST-T changes typical with LBBB pattern (discordant T waves)
Interpreter Comments (printed on ECG):
- "Abnormal Left Axis Deviation, Left Anterior Fascicular Block, Incomplete Right Bundle Branch Block, repolarization abnormality — UNCONFIRMED" (Schiller)
- "Sinus tachycardia, Left Bundle Branch Block, Abnormal ECG — correlate clinically" (GE MAC2000)
Clinical Note:
In the setting of new LBBB + sinus tachycardia in a 74-year-old female, Sgarbossa criteria (or modified Sgarbossa) should be applied if ACS is suspected. QTc prolongation to 504 ms also requires drug review and electrolyte check.
What's the criteria
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Sgarbossa criteria LBBB ACS diagnosis original and modified
Sgarbossa Criteria — ACS Diagnosis in LBBB
Original Sgarbossa Criteria (1996) — Weighted Point System
| Criterion | Finding | Points |
|---|---|---|
| 1. Concordant STE | ST elevation ≥1 mm in a lead where QRS is upward (most specific) | 5 |
| 2. Concordant STD | ST depression ≥1 mm in V1, V2, or V3 | 3 |
| 3. Discordant STE | ST elevation ≥5 mm in a lead where QRS is downward (least specific) | 2 |
Score ≥3 = ~98% probability of STEMI equivalent (high specificity, low sensitivity ~20%)
Smith-Modified Sgarbossa Criteria (2012) — No Point System
Positive if ANY 1 of the 3 criteria is met:
| # | Criterion |
|---|---|
| 1 | ST elevation ≥1 mm concordant with QRS (same direction) — unchanged |
| 2 | ST depression ≥1 mm in V1–V3 — unchanged |
| 3 (modified) | ST/S ratio ≤ −0.25 in any lead with discordant STE (replaces the absolute 5 mm rule) |
Criterion 3 explained: Measure ST elevation relative to the depth of the preceding S wave. If STE ÷ S-wave amplitude ≤ −0.25 (i.e., STE is >25% of the S wave depth), it's positive. This is more sensitive and accounts for QRS amplitude variability.
Modified criteria: Sensitivity 80%, Specificity 99% — superior to original.
Key Concepts
- In LBBB, the normal pattern is discordant (ST goes opposite to QRS) — this is expected and not ischemic
- Concordant ST changes are always abnormal and most specific for ischemia
- A new or presumably new LBBB alone is no longer a STEMI equivalent per current AHA/ACC guidelines (changed ~2013), but Sgarbossa-positive LBBB still warrants cath lab activation
- Applies equally to ventricular paced rhythms (same morphology, same criteria)
Clinical Action
- Sgarbossa positive → Treat as STEMI equivalent → activate cath lab
- Sgarbossa negative but high clinical suspicion → Serial troponins, serial ECGs, cardiology consult
- Apply to Mrs Vasantha if she presents with chest pain/dyspnea — check each lead for concordant changes
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