AMI in (bi)ventricular pacing - do not discard the ECG.

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.