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SAQ 261 – Cardiology – acute myocardial infarction with LBBB

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Marked out of 12.00

A 64-year-old man presents with chest pain. His previous resting ECG and current ECG during pain are shown below.

Previous resting ECG for Geelong SAQ 029 question 5 — Previous resting ECG

Current pain ECG for Geelong SAQ 029 question 5 — Current ECG with pain

State five (5) abnormal findings on the previous resting ECG.

(Marked out of 5.0)

/ 5

State two (2) different abnormal findings on the current ECG.

(Marked out of 2.0)

/ 2

State the significance of the dynamic changes, including evidence-based criteria. Include five (5) statements.

(Marked out of 5.0)

/ 5

Total Score: 0 / 12

Percentage: 0%

Model Answer

Question 5. acute myocardial infarction with LBBB.

a. Previous ECG

Sinus bradycardia at approximately 40/min.
Poor R-wave progression.
Left bundle-branch block.
Biphasic T waves in I, aVL, V5, and V6.
T-wave inversion in aVL.

b. Current ECG

ST elevation in I, aVL, and V2-V5, including concordant elevation and proportionally excessive discordance.
ST depression in II, III, aVF, and V6, including concordant inferior depression.

c. Significance

Dynamic changes suggest acute ischaemia and STEMI.
Chest pain with these findings requires urgent cardiology review and reperfusion therapy.
Concordant ST elevation of at least 1 mm is a positive Sgarbossa feature.
Concordant ST depression of at least 1 mm in V1-V3 is a positive feature.
Discordant ST elevation at least 25% of the preceding S-wave is positive by modified Sgarbossa criteria.
Presence of Sgarbossa criteria is highly specific, although absence has poor sensitivity.

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