There is clearly ST elevation in leads V1-V3. Are we activating the cath lab based on this EKG?
Is this a STEMI?
Searcy EM
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There is clearly ST elevation in leads V1-V3. Are we activating the cath lab based on this EKG?
Searcy EM 
I would say no.
Although there is obvious ST elevation in V1-V3, according to AHA guidelines, the elevation needs to be greater than a certain amount dependent upon gender (and age in men):
Men 40: 2.0 mm in V2 & V3, 1 mm in any other lead
Women: 1.5 mm in V2 & V3, 1 mm in any other lead
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Those things are true. However, I think there is at least 2 mm in V1 and V2 and probably in V3 as well. There is something else going on here…
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I would say no. This appears to be a left bundle branch block, which means Sgarbossa‘s criteria should be used. Although this is an ST elevation greater than 1 mm, it is discordant with the axis. Discordant ST elevations have to be greater than 5 mm to mean anything based on Sgarbossa‘s criteria (although this only adds two points to the scarbossa score, which is essentially meaningless to the outcome of Criteria being met, something that I have never understood).
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I agree with James and Amad and would not activate the Cath lab. Since there is LBBB present then Sgarbossa Criteria can help us decide if this is an EKG consistent with ischemia. The modified Sgarbossa Criteria calls for Proportionally excessive discordant STE in at least 1 lead anywhere that is at least 25% of the depth of the QRS complex instead of just 5mm of discordant elevation. My understanding of this means that if your QRS (I guess it would actually be a QS wave) is 12mm in depth and the discordant STE is at least 3mm or greater then it would meet modified Sgarbossa’s Criteria but not the original criteria. Based on the original criteria if a QS was 25mm deep and the discordant STE was 5mm which is only 20% of the total depth it would be considered a STEMI. However based on the size of the preceding QS, the discordant STE of 5mm may represent normal re-polarization that is appropriately large compared to the larger preceding depolarization event. Im not sure if this make sense but this is what happens in my mind.
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