We know that the Scarbosa Criteria is used to detect AWMI in presence of pre existing LBBB.
Scarbosa Criteria
* 1mm or greater J point elevation in lateral leads v5,v6. (5points)
*1mm or greater J point depression in leads v1,v2,v3. (3 points)
*5mm or greater J point elevation in leads v1,v2,v3 (2 points)
Im considering the third point here for discussion.
Back ground: LBBB is always associated with secondary ST segmant and T wave changes. (Discordant changes)
MI is associated with primary ST segment and T wave changes. (Concordant changes)
So here, in third point of sgarbosa criteria, the J point elevation of 5mm or above is in discordance with QRS complex, which is contrary to the definition of ST-T changes in acute MI. Though there is an elevation of J point, the changes are not in concordance with QRS complex.
Therefore, in my view, points 1 and 2 of Scarbosa criteria are only relevant with the definition of repolarization changes in MI.
But we see patients, who are satisfying only 3rd point of Scagbosa criteria were having RWMA by 2d echo and according to Scarbosa criteria this carries score of 2, but a score of 3 or more only diagnostic to MI.
In my opinion, such cases which are satisfying only 3rd point of Scarbosa criteria could be a case of NSTEMI, with RWMA and elevated enzymes.
Conclusion: 1st and 2nd points of Scarbosa criteria are to diagnose AWMI, in presence of LBBB, and third point to diagnose NSTEMI.
Scarbosa Criteria
* 1mm or greater J point elevation in lateral leads v5,v6. (5points)
*1mm or greater J point depression in leads v1,v2,v3. (3 points)
*5mm or greater J point elevation in leads v1,v2,v3 (2 points)
Im considering the third point here for discussion.
Back ground: LBBB is always associated with secondary ST segmant and T wave changes. (Discordant changes)
MI is associated with primary ST segment and T wave changes. (Concordant changes)
So here, in third point of sgarbosa criteria, the J point elevation of 5mm or above is in discordance with QRS complex, which is contrary to the definition of ST-T changes in acute MI. Though there is an elevation of J point, the changes are not in concordance with QRS complex.
Therefore, in my view, points 1 and 2 of Scarbosa criteria are only relevant with the definition of repolarization changes in MI.
But we see patients, who are satisfying only 3rd point of Scagbosa criteria were having RWMA by 2d echo and according to Scarbosa criteria this carries score of 2, but a score of 3 or more only diagnostic to MI.
In my opinion, such cases which are satisfying only 3rd point of Scarbosa criteria could be a case of NSTEMI, with RWMA and elevated enzymes.
Conclusion: 1st and 2nd points of Scarbosa criteria are to diagnose AWMI, in presence of LBBB, and third point to diagnose NSTEMI.
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