ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Ventricular paced rhythms can hide acute coronary occlusion, and classic STEMI criteria perform poorly in this setting. Modified Sgarbossa criteria improve sensitivity for occlusion MI while preserving useful specificity, making them highly relevant when a paced ECG accompanies symptoms concerning for ACS.
Occlusion MI in Paced Rhythms
- Paced ECG ischemia problem: Ventricular pacing obscures repolarization, so acute coronary occlusion is easy to miss when clinicians rely on standard STEMI pattern recognition alone.
- Modified Sgarbossa advantage: Modified Sgarbossa criteria were as specific and clearly more sensitive than the original Sgarbossa criteria for occlusion MI in ventricular paced rhythm.
- Proportional discordance finding: The most useful single finding was proportionally excessive discordant ST elevation, using the ST-segment to S-wave ratio rather than a fixed millimeter cutoff.
- Concordant depression clue: Adding concordant ST depression in V1 through V6 improved case detection further, a nuance worth hearing in the episode.
- Reperfusion decision support: In a patient with ventricular paced rhythm and ACS symptoms, a positive modified Sgarbossa pattern can meaningfully raise concern for OMI and support emergent cath lab thinking.
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Faculty
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
- Salim Rezaie, MD
