Electrocardiographic diagnosis of acute myocardial infarction in a pacemaker patient: a case report

Abstract

Background The electrocardiographic diagnosis of acute myocardial infarction (AMI) in the setting of cardiac pacing is often challenging. The original Sgarbossa criteria proposed in 1996 were demonstrated to be valid for diagnosis of AMI in both ventricular paced rhythm and left bundle branch block. To improve accuracy, the modified Sgarbossa criteria (MSC) were proposed. Case presentation We presented a case of electrocardiographic diagnosis of AMI in a pacemaker patient. The Electrocardiogram (ECG) was false negative by using the original Sgarbossa criteria, whereas true positive by the MSC at a ratio of − 0.20. Conclusions The application of MSC using an appropriate ratio (− 0.20 or − 0.25) may facilitate a timely diagnosis of AMI. Physicians should carefully choose the appropriate cutoff in a case-by-case basis.

Electrocardiographic acute inferior myocardial infarction with right ventricle involvement due to acute thrombotic left anterior descending occlusion in a patient with atrial septal defect

“…1,2 However, it is not easy to make a diagnosis in case of bundle branch block, pacemaker rhythm, underlying structural heart disease, or anatomically-dislocated heart. [1][2][3] Additionally, the localization of a culprit artery via looking at the ECG findings can be time-saving in case of unstable patients, but correlation of culprit artery and ECG findings cannot be perfect always, especially in the presence of underlying ECG changes. Thus, reporting this kind of "outof-standard" example may have potential benefit for the physicians in their clinical judgment.…”