In the Emergency Department, the diagnosis of acute myocardial infarction (AMI) relies initially on a patient’s history and the 12-lead electrocardiogram (ECG). Establishing the diagnosis of AMI in the left bundle branch block (LBBB) is difficult and can result in delay of definitive treatment. In 1996, Sgarbossa found 3 ECG criteria to evaluate for AMI in patients with LBBB.
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Electrocardiographic Diagnosis of Left Ventricular Hypertrophy (LVH)
Sokolow-Lyon index:
There are two criteria with these widely used indices:
* Sum of S wave in V1 and R wave in V5 or V6 >/= 3.5 mV (35 mm)
and/or
* R wave in aVL >/= 1.1 mV (11 mm)
Common Diagnostic Criteria for Left and Right Atrial Abnormalities
Left Atrial Abnormality
- Prolonged P wave duration of >120 msec in lead II
- Prominent notching of the P wave, usually most obvious in lead II, with an interval between the notches of >40 msec (p mitrale)
- Ratio between the duration of the P wave in lead II and the duration of the PR segment of >1.6
- Increased duration and depth of the terminal negative portion of the P wave in lead V1 (the P terminal force) so that the area subtended by it exceeds 0.04 mm-sec (Morris index)
- Leftward shift of the mean P wave axis to between -30 and +45 degrees