Dr. Roig Profile picture
Jan 18, 2024 14 tweets 5 min read Read on X
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 Image
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.Image
3/ The Sgarbossa Criteria were initially introduced in 1996 by @ElenaSgarbossa et al. They used data from the famous GUSTO-1 trial.

Article🔗 nejm.org/doi/10.1056/NE…
Image
4/ Subsequent modifications by other authors have aimed to improve sensitivity.

Modified Sgarbossa Criteria by @smithECGBlog et al. 2012.

Article 🔗 annemergmed.com/article/S0196-…
Image
5/ Barcelona Criteria by Andrea Di Marco et al. 2020.

Article 🔗 ncbi.nlm.nih.gov/pmc/articles/P…
Image
6/ Here an EKG with classic LBBB and no acute MI. Image
7/ Below are few examples of acute myocardial infarction in the setting of LBBB.

Courtesy of @syamkumarmd
8/ Another sample of acute MI in the setting of LBBB.

Courtesy of ECG Medical Training. Image
9/ Another sample of acute MI in the setting of LBBB.

Red circle shows concordant ST segment elevation. Courtesy of Dr. Carlos Pineda from ECG Weekly. Image
10/ Regarding diagnostic accuracy and sensitivity-specificity for each criteria, please consult the references.

🔗 ekgdx.com/references/#Sg…
Image
11/ Who or what is Sgarbossa?

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.
13/ More info available in the blog of @ekgdx

Read here: ekgdx.com/blog/sgarbossa…
14/ End

Thanks for reading this 🧵.

If you find this content helpful, please:

1- Follow @doctor_roig and @ekgdx for more.
2- Repost the first tweet for support.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Dr. Roig

Dr. Roig Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @doctor_roig

Nov 14, 2024
1/ Today's 🧵is the ROIG Method.

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.

#CardioX #CardioTwitter #ekgdx Image
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.

Here we go!
3/ The first step is to calculate the Rate. Image
Read 18 tweets
Jun 8, 2024
1/ Today's 🧵is about a teaching case.

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

#ekgdx #CardioTwitter #CardioX Image
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.

See more cases here: 

#ekgdx #CardioTwitter #CardioX @ekgdx ekgdx.com/board/ekg
Image
3/ The following EKG was performed in 2008.

Note the absence of inverted T waves in the inferior leads.

#ekgdx #CardioTwitter #CardioX Image
Read 15 tweets
May 19, 2024
1/ Today's 🧵is about a case.  

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.

#ekgdx #CardioTwitter #CardioXImage
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.

@ekgdx #ekgdx #CardioTwitter #CardioX Image
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.

@ekgdx #ekgdx #CardioTwitter #CardioX Image
Read 11 tweets
May 13, 2024
1/ Today's 🧵is about "STEMI Equivalents".

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.

@ekgdx #ekgdx #CardioTwitterImage
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).

Link:

@ekgdx #ekgdxsciencedirect.com/science/articl…Image
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.

Link: 

@ekgdx #ekgdxjacc.org/doi/10.1016/j.…Image
Read 18 tweets
Feb 29, 2024
1/ Today's 🧵is about "Premature Atrial Complex (PAC)".

The aim of this thread is to refresh basic concepts that may help you to identify the different types of PACs.

I will explain it in a simple way with classic examples.

#CardioTwitter #ekgdx @ekgdx Image
2/ PAC occurs when an ectopic focus within the atria, generates an action potential before the next scheduled sinus beat.

In general:

*PAC can be Conducted normally, Aberrantly conducted or Blocked (non-conducted).
*PAC can be conducted with short PR, normal PR or long PR interval.

Let's start with a conducted #PAC that presents RBBB #aberrancy.

#ekgdx @ekgdxImage
3/ Another sample of conducted PACs (red arrows) with RBBB aberrancy (ovals) in a pattern of trigeminy. Courtesy of @ekgdx

Sometimes the PACs can be merged with the preceding T wave.

#ekgdx Image
Read 17 tweets
Feb 18, 2024
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.

@ekgdxImage
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.

Article:

@ekgdxsciencedirect.com/science/articl…Image
3/ In the past 40 years, several algorithms or criteria have been developed to differentiate VT from SVT. Here I show you some of them:

Kindwall Criteria

Article:

Courtesy of pubmed.ncbi.nlm.nih.gov/3376886/
ekgdx.com/board/ekg
Image
Read 17 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(