Identifying acute myocardial infarction in ventricular-paced patients: The effectiveness of modified Sgarbossa criteria.
The American journal of emergency medicine
Screening for acute myocardial infarction (AMI) in patients with ventricular pacemakers (VP) is a diagnostic challenge. We report a case where application of the Modified Sgarbossa criteria (mSC) would have immediately identified AMI in a patient with a VP and merited strong advocacy for emergent cardiac catheterization. A 94-year-old male with VP presented to the emergency department (ED) after he had burning sensation in his chest. Initial ECG demonstrated >5 mm of discordant ST elevation in leads III and aVF which gave him 2 points per original Sgarbossa Criteria (oSC) and not meeting criteria for activation for cardiac catheterization. An ECG at three and a half hours after arrival demonstrated a dynamic change with new V2 concordant depression. At this point, the concordant depression (3 points) and excessive discordance (2 points) gave him a total of 5 points, which then met the oSC for activation of cardiac catheterization (≥ 3 points). Troponin I value (ng/mL) at 0/2/4 h after ED arrival are 0.02, 0.08 and 4.33 respectively. Pain never recurred after single nitroglycerine (NTG) tablet upon arrival. He was urgently taken for catheterization and had acute right coronary artery (RCA) culprit lesion and discharged on hospital day 4. This case report highlighted the benefits of applying mSC to patients with VP, which to authors knowledge remains unvalidated. A significant benefit of mSC is that they are unweighted, thus any positive criteria is suggestive of AMI. While the first EKG yielded an oSC score
Newson JM, Sefa N, Berger DA. Identifying acute myocardial infarction in ventricular-paced patients: The effectiveness of modified Sgarbossa criteria. Am J Emerg Med. 2021 Jul;45:680.e1-680.e4. doi: 10.1016/j.ajem.2020.11.068. Epub 2020 Dec 5. PMID: 33436316.