Smith-Modified Sgarbossa Criteria and Paced Rhythms: A Case Report

Abstract

BackgroundAs the incidence of left bundle branch blocks (LBBBs) and paced-rhythms electrocardiograms (ECGs) increase in the aging global population, the need for rapid and accurate diagnosis of ST-elevation myocardial infarction (STEMI) or STEMI equivalents in patients with these rhythms becomes more imperative. The Sgarbossa and Smith-modified Sgarbossa criteria have been documented to enhance the diagnosis of STEMI in the setting of LBBBs. However, there is a growing body of literature that suggests that these criteria can also be applied for the diagnosis of STEMI in patients with paced rhythms. Case ReportWe present the case of an 84-year old man who was on admission for cellulitis when he developed acute respiratory distress. An ECG revealed findings that were consistent with positive Smith-modified Sgarbossa criteria, upon which the diagnosis of STEMI was made. Why Should an Emergency Physician Be Aware of This?Although the sensitivity and specificity of these criteria in paced rhythms is not well documented, if a patient meets these criteria in an appropriate clinical setting, cardiac catheterization laboratory activation by an emergency physician could be appropriate.