Amal Mattu’s ECG Case of the Week – June 1, 2015 To view the remainder of this post you must be logged in or have an ECGWeekly account. If you cannot view this post and are logged in, then the post is outside of your subscription coverage. Please contact support to have us check your account. Log In Click here to purchase an annual account By ECGWeekly Support|2016-12-21T17:14:55-04:00June 1st, 2015|10 Comments Share This Story, Choose Your Platform! FacebookTwitterLinkedInGoogle+TumblrPinterestEmail Related Posts Amal Mattu’s ECG Case of the Week – October 21, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 21, 2019 Amal Mattu’s ECG Case of the Week – October 14, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 14, 2019 Amal Mattu’s ECG Case of the Week – October 7, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 7, 2019 Amal Mattu’s ECG Case of the Week – September 30, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 30, 2019 Amal Mattu’s ECG Case of the Week – September 23, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 23, 2019 10 Comments Zach Banks June 1, 2015 at 11:41 am Log in to Reply Great episode! Very helpful as always! I have a quick question though, which is probably pretty basic, but what does it mean when you say Sgarbossa Criteria A and B are very specific but not very sensitive? Whats the difference between specificity and sensitivity in this context? Amal Mattu June 2, 2015 at 3:45 pm Log in to Reply High specificity: If you see this finding, it’s almost definitely an MI. > 90% likely to be an MI. Low sensitivity: It’s not that common. i.e. if a patient with LBBB is having an MI, you’ll see the Sgarbossa findings in < 1/3 of the patients. So the bottom line is that if you don't see it, you can't rule out ACS; but if you see it, be worried! Martin Medviď June 2, 2015 at 6:09 pm Log in to Reply Dr. Mattu, I have a spicy question. In your presented Ecg I saw there also a concordant STD in inferior Leads and wondering what if that patient would have only this findings in a presence of LBBB. I remember you mentioned that it is not actually V1-V3, but why only this leads. I am not well experienced yet but I saw a couple of ECGs of lateral MI (but free of LBBB), with marked STD inferiorly but only with subtle changes in mostly aVL. Thats why for me also in a presence of LBBB a concordant STD in III and aVF would make me worrisome. Thank you for another great lecture:) Amal Mattu June 3, 2015 at 9:59 pm Log in to Reply Great question! I don’t know why Sgarbossa and colleagues only comment on STD in leads V1-V3. It seems like it should be applicable to other leads where the main QRS is pointing down as well (e.g. the inferior leads)l, but that’s what they reported. Perhaps they looked at those other leads and simply found that it is not reliable outside V1-V3? Not sure…. If I ever have a chance to meet her, I’ll ask! So in my practice, if the concordant STD is in V1-V3, I’d activate the cath lab or give lytics. But if the concordant STD is only in other leads, I would simply get serial ECGs, have cardiology take a look also, and make a decision in conjunction with them. Tyler Christifulli June 15, 2015 at 6:46 am Log in to Reply This LAD occlusion presented with excessive STE in the inferior leads as well as V3.. Would this make you suspicious of a left dominant patient or type 3 LAD? Amal Mattu June 28, 2015 at 12:38 pm Log in to Reply Tyler, It turns out the it’s very difficult to predict the infarct related artery when someone has a LBBB. However, anecdotally I’d say that almost all of the MIs I’ve seen in patients with LBBB turn out to be LAD. michael halberg June 26, 2015 at 4:17 pm Log in to Reply Excellent case. I have never activated based on Sgarbossa. I have activated based on “new” LBBB and signs of failure but never LBBB with concordance. I am wondering how many times you have seen this in daily clinical practice. Amal Mattu June 28, 2015 at 12:37 pm Log in to Reply Michael, I have activated only a few times for this, and my colleagues have also. It’s not a common thing. The importance of knowing these findings is in the high specificity, not the sensitivity. On a related note, our cardiologists for many years have been fairly unconcerned about a new LBBB unless the patient is unstable (or had Sgarbossa findings). It seems they knew about the lack of utility of new LBBB based on their experience for many years prior to the change in guidelines. I’ve heard the same regarding many other cardiology groups as well. Stethoscope Nunchucks June 27, 2015 at 2:51 pm Log in to Reply Great post per usual. Really helped clear up the revised criteria C stuff. I remember reading about the new criteria on Dr. Smith’s blog and the math seemed a LOT more comiplex back then. But maybe I’m just bad at math. InkaRN January 4, 2018 at 12:17 am Log in to Reply another great lecture! thank you. Leave A Comment Cancel replyYou must be logged in to post a comment.