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EKG


Sgarbossa Criteria

1. ST elevation ≥ 1 mm concordant with QRS complex (most predictive of AMI of the 3 criteria)
2. ST depression ≥ 1 mm in lead V1, V2, or V3
3. ST elevation ≥ 5 mm where discordant with QRS complex

Modified 3rd rule: ST elevation ≥ 0.25 x S-wave (Ann Emerg Med. 2012 Dec;60(6):766-76)

Left Ventricular Hypertrophy

The Sokolow-Lyon index:

  • S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm
  • R in aVL ≥ 11 mm

The Cornell voltage criteria:

  • S in V3 + R in aVL > 28 mm (men)
  • S in V3 + R in aVL > 20 mm (women)

Romhilt-Estes point score system ("diagnostic" >5 points; "probable" 4 points):

ECG CriteriaPoints
Voltage Criteria (any of):
  1. R or S in limb leads ≥20 mm
  2. S in V1 or V2 ≥30 mm
  3. R in V5 or V6 ≥30 mm
3
ST-T Abnormalities:
  • ST-T vector opposite to QRS without digitalis
  • ST-T vector opposite to QRS with digitalis

3
1

Negative terminal P mode in V1 1 mm in depth and 0.04 sec in duration (indicates left atrial enlargement)3
Left axis deviation (QRS of -30° or more)2
QRS duration ≥0.09 sec1
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec)1

Other voltage-based criteria for LVH include:

  • Lead I: R wave > 14 mm
  • Lead aVR: S wave > 15 mm
  • Lead aVL: R wave > 12 mm
  • Lead aVF: R wave > 21 mm
  • Lead V5: R wave > 26 mm
  • Lead V6: R wave > 20 mm

Pericarditis

Echo: normal LV myocardial thickness (end-diastole) 0.6-1.1cm



Practice EKG Interpretation: http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

Lewis Lead for atrial activity:  http://emcrit.org/wee/lewis-lead/ 

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RV Infarct, Posterior Infarct  294k v. 1 Oct 3, 2011, 4:42 PM Kit Tainter
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