ECG
Sgarbossa, Smith-modified & Barcelona
Scores the original Sgarbossa criteria, applies the Smith modification (ST/S ratio ≤ −0.25 in place of the 5 mm discordant rule) and the Barcelona algorithm, to identify acute myocardial infarction when LBBB or a paced rhythm obscures the ECG.
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Underlying rhythm
Concordant ST changes
ST deviation in the same direction as the QRS
Discordant ST elevation
Lead with a negative QRS and the most ST elevation relative to its S wave
Low-voltage leads (Barcelona)
Sgarbossa · LBBB
Tick the ST changes present, or enter the discordant ST elevation and S-wave depth.
References
- Sgarbossa EB, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med 1996;334:481-487.
- Smith SW, et al. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med 2012;60:766-776.
- Di Marco A, et al. New electrocardiographic algorithm for the diagnosis of acute myocardial infarction in patients with left bundle branch block. J Am Heart Assoc 2020;9:e015573.
- Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-3826.