The Sgarbossa criteria is used in the diagnosis of an acute myocardial infarction when a LBBB is present.
Traditionally, it has been taught that MI is not able to be diagnosed via ECG in the presence of a LBBB. However, Sgarbossa et al described in 1996 some ECG changes seen in patients with LBBB and concomitant MIs and devised a point scoring system. This is called the Sgarbossa criteria, and they are listed below.
ST segment elevation > 1 mm and in the same direction (concordant) with the QRS complex = 5 points
ST segment depression > 1 mm in leads V1, V2 or V3 = 3 points
ST segment elevation > 5 mm and in the opposite direction (discordant) with the QRS = 2 points
A score of 3 points is required to diagnose an acute MI. Criteria #3 is under debate as to its usefulness; therefore, either criteria 1 or criteria 2 are essentially required.


Modified Sgarbossa Criteria:

≥ 1 lead with ≥ 1 mm of concordant ST elevation
≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.



There is 1mm concordant ST elevation in aVL (= 5 points).
Other features on this ECG that are abnormal in the context of LBBB (but not considered “positive” Sgarbossa criteria) are the pathological Q wave in lead I and the concordant ST depression in the inferior leads III and aVF.
This constellation of abnormalities suggests to me that the patient was having a high lateral infarction.



There is concordant ST depression in V2-5 (= Sgarbossa positive).
The morphology in V2-5 is reminiscent of posterior STEMI, with horizontal ST depression and prominent upright T waves.