Sgarbossa criteria used to identify cardiac ischemia in patient with ventricular paced rhythm

Area of Science:

• Cardiology
• Electrocardiography
• Emergency Medicine

Background:

• The Sgarbossa criteria are used to diagnose myocardial ischemia on electrocardiograms (ECGs).
• Their performance in patients with ventricular pacing is not well-established, with existing research suggesting low sensitivity but high specificity.
• Ventricular pacing can significantly alter ECG findings, complicating ischemia interpretation.

Observation:

• A 73-year-old male presented with acute chest pain and a history of hypertension and a pacemaker for type 2 second-degree atrioventricular block.
• His initial ECG met all three Sgarbossa criteria (ST elevation ≥1 mm in leads with a predominantly positive QRS complex, ST elevation ≥1 mm in V1-V3, and ST depression ≥1 mm in leads V4-V6).
• Coronary angiography revealed a culprit lesion in the posterior descending artery.

Findings:

• The Sgarbossa criteria were fulfilled in a patient with ventricular pacing and acute myocardial infarction.
• The presence of all three criteria strongly suggested acute myocardial ischemia despite the paced rhythm.

Implications:

• This case underscores the importance of considering the Sgarbossa criteria in patients with ventricular pacing presenting with chest pain.
• Applying these criteria can lead to earlier identification of myocardial ischemia and facilitate timely reperfusion therapy.
• Further research is warranted to fully elucidate the diagnostic accuracy of the Sgarbossa criteria in this specific patient population.