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AMI in (bi)ventricular pacing - do not discard the ECG
T Versyck1, D Devriese1, S Smith2,3
1Department of Emergency Medicine, Saint Lucas Hospital, Ghent, Belgium.
Insights
The Smith-modified Sgarbossa criteria can help diagnose ST-segment elevation myocardial infarction (STEMI) in patients with ventricular paced rhythms. Early application of these criteria can aid in timely diagnosis and treatment for acute myocardial infarction (AMI).
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Growing number of patients with ventricular paced rhythms presenting with chest pain.
- Challenges in diagnosing ST-segment elevation myocardial infarction (STEMI) due to uninterpretable ECGs in paced rhythms.
- Need for reliable diagnostic tools for acute myocardial infarction (AMI) in this population.
Observation:
- Presents three case reports of patients with chest pain and ventricular pacing (right or biventricular).
- Electrocardiograms (ECGs) were analyzed in the context of chest pain and paced rhythms.
- Focus on the utility of specific ECG interpretation criteria.
Findings:
- Smith-modified Sgarbossa criteria were positive in all three reported cases.
- These criteria could have facilitated early STEMI diagnosis.
- Demonstrates the applicability of modified Sgarbossa criteria in paced ECGs.
Implications:
- Highlights the importance of recognizing ST-segment deviations in paced ECGs.
- Suggests comparing current symptomatic ECGs with previous asymptomatic ECGs.
- Emphasizes the need for emergency physicians and cardiologists to be familiar with these criteria for rising AMI cases in paced patients.
Background:
There is a growing number of patients with ventricular paced rhythm, who present to the emergency department with chest pain. The diagnosis of ST-segment elevation myocardial infarction (STEMI) and subsequent percutaneous coronary intervention (PCI) is often postponed, as the 12 leads-electrocardiogram (ECG) is discarded as not interpretable. There is a growing body of literature that suggests that Smith-modified Sgarbossa criteria can be applied for the diagnosis of STEMI in patients with paced rhythms. These criteria were originally developed for the interpretation of ECGs in patients with a left bundle branch block (LBBB) and chest pain, but have been expanded to paced ECGs.
Methodology:
We present three case reports with chest pain and right ventricular or biventricular pacing.
Findings:
In all three cases, the Smith-modified Sgarbossa was positive and the diagnosis of STEMI could have been made early on.
Implications:
It remains important to look for ST-segment deviations and to compare the symptomatic ECG with previous asymptomatic ECGs. As the number of patients with potential acute myocardial infarction (AMI) and paced rhythms is likely to rise in the future, these criteria should be known to emergency physicians and cardiologists.
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