Join in the conversation between Scott Weingart and Steve Smith as they discuss who should go to the cath lab on Dr. Scott Weingart's EMCRIT two part podcast or check out the pdf cheat sheet from Dr. Smith on which patients should go to the cath lab and when to engage you cardiologist for consult.

Dr. Smith urges us to know the Sgarbossa Criteria and advocate for our patients.  Start with his blog post here:

Remember:​
The original criteria used to diagnose MI in patients with LBBB are:

• Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
• Concordant ST depression > 1 mm in V1-V3 (score 3)
• Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (score 2).

A total score of  ≥ 3 has a specificity of 90% for MI.

Also check out the modified Sgarbossa Criteria from Dr. Smith's blog

• ≥ 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.

Also check out this great summary from LITFL.

Specific for proximal LAD occlusion.  Important not to miss as medical management typically not effective for proximal lesions, they need the cath lab.

• Type I : Symmetric, deep T wave inversion
• Type II: Biphasic T waves

Note: Pt may be pain free and troponins negative!

Check out LITFL with a list of criteria for Wellen's per Rhinehart et al

Review of DeWinter's Waves from LITFL.  Also check out Amal Mattu's video.
BLUF: This is a STEMI equivalent that can represent acute occlusion of the LAD that needs to be treated immediately.

Pattern:

• ​Seen in precordial leadsd
  • ST segment depression > 1mm with upsloping
  • Tall, symmetric T waves
• May see subtle ST segment elevation in aVR
• Can precede or be followed by classic STEMI pattern