Related Experiment Video
Updated: Mar 15, 2026
Uncovering Beat Deafness: Detecting Rhythm Disorders with Synchronized Finger Tapping and Perceptual Timing Tasks
Published on: March 16, 2015
Smith-Modified Sgarbossa Criteria and Paced Rhythms: A Case Report
1Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Insights
The Smith-modified Sgarbossa criteria can aid in diagnosing ST-elevation myocardial infarction (STEMI) in patients with paced rhythms. Emergency physicians should consider these criteria for timely cardiac catheterization laboratory activation.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Increasing incidence of left bundle branch blocks (LBBBs) and paced rhythms in the elderly necessitates improved ST-elevation myocardial infarction (STEMI) diagnosis.
- The Sgarbossa and Smith-modified Sgarbossa criteria are established for STEMI diagnosis in LBBB.
- Emerging evidence suggests applicability of these criteria in paced rhythms.
Observation:
- An 84-year-old male presented with acute respiratory distress.
- Electrocardiogram (ECG) showed findings consistent with positive Smith-modified Sgarbossa criteria.
- STEMI diagnosis was made based on these ECG findings.
Findings:
- The case highlights the potential utility of the Smith-modified Sgarbossa criteria in diagnosing STEMI in patients with paced rhythms.
- While sensitivity and specificity in paced rhythms are not fully established, positive criteria warrant consideration.
Implications:
- Emergency physicians can utilize these criteria to identify potential STEMI in patients with paced rhythms.
- Prompt recognition may lead to appropriate cardiac catheterization laboratory activation.
- This approach can improve outcomes for a challenging patient population.
Background:
As the incidence of left bundle branch blocks (LBBBs) and paced-rhythms electrocardiograms (ECGs) increase in the aging global population, the need for rapid and accurate diagnosis of ST-elevation myocardial infarction (STEMI) or STEMI equivalents in patients with these rhythms becomes more imperative. The Sgarbossa and Smith-modified Sgarbossa criteria have been documented to enhance the diagnosis of STEMI in the setting of LBBBs. However, there is a growing body of literature that suggests that these criteria can also be applied for the diagnosis of STEMI in patients with paced rhythms.
Case Report:
We present the case of an 84-year old man who was on admission for cellulitis when he developed acute respiratory distress. An ECG revealed findings that were consistent with positive Smith-modified Sgarbossa criteria, upon which the diagnosis of STEMI was made. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although the sensitivity and specificity of these criteria in paced rhythms is not well documented, if a patient meets these criteria in an appropriate clinical setting, cardiac catheterization laboratory activation by an emergency physician could be appropriate.
Related Concept Videos
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:24ECG Interpretation of Rhythms
Components of the Electrocardiogram
The primary components of a normal ECG waveform in Normal sinus rhythm(NSR) include the P wave, PR interval, QRS complex, ST segment, T wave, and occasionally a U wave.
ECG waveforms are divided by vertical and horizontal lines at standard intervals.
The horizontal axis measures time and rate, and the vertical axis measures amplitude or voltage....
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:28Dysrhythmias II: Classification of Tachyarrhythmias
01:29Dysrhythmias III: Characteristics of Dysrhythmias