STAT ECG Diagnoses: left bundle branch block (LBBB) basics and expected findings with a focus on how to diagnose acute coronary occlusion myocardial infarction in these patients

ECG Weekly Workout with Dr. Amal Mattu


A 85-year-old woman with a known history of LBBB presents to the ED with chest pain concerning for acute ischemia. The following ECG is obtained: 

Before watching the video, look closely at this ECG and ask yourself these questions:

  1. Is the ECG useful in the diagnosis of acute MI in patients with LBBB?
  2. What findings on this ECG are suggestive of acute coronary occlusion MI?
  3. Aside from the Sgarbossa criteria and modified Sgarbossa criteria, are there any other ECG criteria that are potentially more sensitive in diagnosing acute MI in LBBB?
  4. Would you activate the cath lab?