ECG S

Sgarbossa criteria
Burns E. Sgarbossa Criteria (November 15, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/sgarbossa/
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In patients with left bundle
branch block (LBBB) or
ventricular paced rhythm,
infarct diagnosis based on
the ECG is difficult.
The baseline ST segments
and T waves tend to be
shifted in a discordant
direction (appropriate
discordance), which can
mask or mimic acute
myocardial infarction.
Sgarbossa criteria

Original sgarbossa criteria
Concordant ST elevation >1mm in leads
with a positive QRS complex!
Concordant ST depression >1 mm in V1-V3!
Excessively discordant ST elevation >5 mm in
leads with a positive QRS complex!

Original sgarbossa criteria
ECGMedicalTraining.com 5
Concordant ST elevation >1mm
in leads with a positive QRS complex!
Excessively discordant ST elevation >5 mm
in leads with a positive QRS complex!
Concordant ST depression
>1 mm in V1-V3!

Modified Sgarbossa criteria
≥1 lead with ≥1 mm of concordant ST
elevation
≥1 lead of V1-V3 with ≥1 mm of concordant ST
depression
≥1 lead anywhere with ≥1 mm ST elevation and
proportionally excessive discordant ST elevation
(≥ 25% of the depth of the preceding S-wave)

STEMI
Burns E. STEMI. Lifeinthefastlane.com

Anterior STEMI
• Anterior STEMI results from the occlusion of the left
anterior descending artery (LAD).
HeartUpdate.com

Anterior STEMI
STEMI nomenclature based on the location of
the maximal ST elevation:
Septal STEMI V1-V2
Anterior STEMI V2-V5
Anteroseptal STEMI V1-V4
Anterolateral STEMI V3-V6, DI, aVL
Extensive anterior/anterolateral V1-V6, DI, aVL
Septal precordial leads V1, V2
Anterior V3, V4
Lateral V5, V6

Anterior-inferior STEMI
• It is due to occlusion of a “wraparound” LAD.
ECG pattern:
• simultaneous ST elevation in the precordial
and inferior leads due to occlusion of a variant
(type III) LAD
Type III LAD wraps around the cardiac apex to supply
both the anterior and inferior walls of the left
ventricle.

Anterior-inferior STEMI

Left main coronary artery occlusion
• Widespread ST depression with ST elevation in
aVR that is bigger than in V1.
Healio.com

High lateral STEMI
ST elevation
primarily
localized to
leads DI and
aVL is
referred to
as a high
lateral
STEMI.
It is usually
associated
with
reciprocal ST
depression
and T wave
inversion in
the inferior
leads (DII,
DIII and
aVF).
Occlusion of
the first
diagonal
branch (D1)
of the left
anterior
descending
artery (LAD)
may produce
isolated ST
elevation in
DI and aVL.
Occlusion of
the
circumflex
artery may
cause ST
elevation in
DI, aVL along
with leads
V5-V6.

High lateral STEMI
ST elevation in DI and aVL with reciprocal ST depression in DII, DIII and aVF.

Inferior STEMI
40-50% of all myocardial infarctions!
Up to 40% of patients with an inferior STEMI will have a
concomitant right ventricular infarction.
Up to 20% of patients with inferior STEMI will develop
significant bradycardia due to II. or III. AV block.
Inferior STEMI may also be associated with posterior
infarction with worse prognosis.

Inferior STEMI
ST elevation in leads DII,
DIII and aVF!
Progressive development of Q
waves in DII, DIII and aVF!
Reciprocal ST depression in
aVL (± lead DI)!

Inferior STEMI
• 80% of inferior STEMI are due to occlusion of
the dominant right coronary artery (RCA).
• 18% of inferior STEMI are due to occlusion of
the dominant left circumflex artery (LCx).
• Occasionally, inferior STEMI may result from
occlusion of a “type III” or “wraparound” left
anterior descending artery (LAD) with the
unusual pattern of concomitant inferior and
anterior ST elevation.

Inferior STEMI
ST elevation in DII, DIII and aVF with reciprocal ST depression in aVL.

Lateral STEMI
• The lateral wall of the LV is supplied by branches of
the left anterior descending (LAD) and left circumflex
(LCx) arteries.
• Infarction of the lateral wall usually occurs as part of
a larger territory infarction-anterolateral STEMI.
• Isolated lateral STEMI is less common, but may be
produced by occlusion of smaller branch arteries that
supply the lateral wall: the first diagonal branch (D1)
of the LAD, the obtuse marginal branch (OM) of the
LCx or the ramus intermedius.

Lateral STEMI
ST elevation in the lateral
leads (DI, aVL, V5-V6).
Reciprocal ST depression in the
inferior leads (DIII and aVF).

ST elevation in DI and aVL, subtle ST elevation with hyperacute T
waves in V5 and V6, reciprocal ST depression in DIII and aVF.

Posterior STEMI
•Posterior infarction accompanies 15-20%
of STEMIs, usually occurring in the
context of an inferior or lateral
infarction.
•Isolated posterior myocardial infarction
is less common (3-11% of infarcts).

Posterior STEMI
Changes in V1-V3 include:
• horizontal ST depression
• tall, broad R waves (>30ms)
• upright T waves
• dominant R wave (R/S ratio >1) in V2

Posterior STEMI
Horizontal ST depression, tall broad R waves, upright T waves!

Right STEMI

Right STEMI
•ST elevation in V1!
•ST elevation in DIII >DII!
•ST elevation in V1 >V2!
•ST elevation in V1 + ST depression in V2!
•Isoelectric ST segment in V1 with marked
ST depression in V2!

Right STEMI
ST elevation in DIII >DII!
ST elevation in V1!

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