1/ Today's 🧵 is about the #Sgarbossa Criteria and #Concordance vs #Discordance in simple words.
The objective of this post is to clarify any doubts in a simple, graphic and didactic way. #CardioTwitter @ekgdx
2/ The Sgarbossa criteria were initially introduced over two decades ago to enhance the diagnostic precision for MI in the setting of LBBB. This criteria is widely accepted as one of the most valuable tools to assist in the diagnosis of MI when LBBB is present.
Here you can see a classic example with graphic explanations that will facilitate understanding.
3/ The Sgarbossa Criteria were initially introduced in 1996 by @ElenaSgarbossa et al. They used data from the famous GUSTO-1 trial.
Elena B. Sgarbossa, MD (@ElenaSgarbossa ), is an American cardiologist, author, and medical translator, originally from Argentina. This criteria is widely accepted as one of the most valuable tools to assist in the diagnosis of MI when LBBB is present.
12/ Take this home
✅ Sgarbossa criteria was a game changer.
✅ Subsequent modifications by other authors have aimed to improve sensitivity. You must study all of them.
✅ You can’t rule out an acute myocardial infarction if the criteria are absent.
The aim of this thread is to provide "basic" steps for reading an EKG.
If you have a problem reading an EKG, this 🧵is for you.
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2/ In the beginning, as novices, many doctors, nurses, and students struggle with accurately interpreting an electrocardiogram. This challenge is often due, among other factors, to a lack of organization in the interpretation process. When I was a medical student, I faced the same issue until one day I decided to create an organized approach. That's when the idea of using my last name, ROIG, as an acronym was born, to help me streamline the process. Everyone eventually develops their own way of reading an EKG, but if you're just starting out, this basic method may help you.
The goal of this thread is to help you understand with real examples the importance of thinking beyond myocardial infarction in those patients with chest pain and elevated troponin levels.
Courtesy of @ekgdx
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2/ A 61 year-old male c/o chest pain radiating to the back and left arm weakness for the past 3 hrs. The EKG shows inverted T waves in III and aVF with high levels of troponin.
An interesting case with a series of three EKGs that show beautiful changes, from hyperacute T waves to abnormal Q waves, and even a transitory periprocedural atrial fibrillation. Courtesy of @ekgdx.
A 59-year-old male, smoker with chest pain for 40 min.
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2/ The first EKG was obtained in triage.
Note the presence of ST-segment elevation with hyperacute T waves in the inferior leads. Reciprocal ST-segment depression is also present. Consistent with an inferior acute MI.
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3/ Angiogram
The patient was rushed to the cath lab. The angiogram showed total occlusion of the distal RCA with TIMI 0 flow. Non obstructive CAD of the left coronary system.
The aim of this thread is to provide a basic guidance on recognizing EKG patterns in cases with coronary artery occlusion where the ST-segment elevation is not present in contiguous leads.
Based on the expert consensus published by the American College of Cardiology in 2022.
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2/ For the last twenty years, studies have demonstrated that acute coronary occlusion (ACO) does not always produce the classic ST-segment elevation in contiguous leads (Koyama et al Am J Cardiol 2002). In fact, the following study has suggested that >25% of patients with ACO will not demonstrate expected ST-segment elevation (Wang, T. @CMichaelGibson et al Am Heart J 2009).
3/ In 2022, the American College of Cardiology published the expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department.
Most notably for our debate, the panel highlighted causes of non-ST elevation acute coronary occlusion, or what they refer to as "STEMI Equivalents.
1/ Today's 🧵is about "VT" versus "SVT with aberrancy".
The aim of this thread is to provide basic tips on how to apply some of the most used criteria that might be helpful in diagnosing VT. #CardioTwitter
Note that the following features are suggestive of VT, but their absence does not exclude VT.
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2/ History
In 1960 Dr. Alfred Pick and Richard Langendorf published, “Differentiation of supraventricular and ventricular tachycardia.” Sixty years later, differential diagnosis of wide QRS tachycardia on the electrocardiogram remains a challenging exercise.