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Acute myocardial infarction in patients with left bundle branch block
  1. Matt Shepherd1,
  2. Richard Hardern2
  1. 1Registrar
  2. 2Consultant, Acute Medical Assessment Area, The General Infirmary, Great George Street, Leeds LS1 3EX

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    Editor,—We read with interest the paper about the electrocardiographic diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB).1 It emphasises the difficulties many have had with electrocardiogram (ECG) interpretation in this situation and explains clearly how to use the criteria of Sgarbossa et al.2 It concludes that these criteria can be used to identify patients with LBBB and AMI.

    It is essential that accident and emergency staff recognise this group of patients so that thrombolysis is delivered promptly. Shlipak et al reviewed patients presenting with LBBB and an acute cardiopulmonary history and assessed the usefulness of the Sgarbossa criteria.3 They found that these criteria had a sensitivity of 10% and a specificity of 100%. Although an ECG that satisfies the criteria is almost certainly indicative of AMI, most (90%) patients with AMI will not meet the criteria. If thrombolytics were to be withheld unless the criteria were met, few patients …

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