New LBBB alone is no longer a reason to activate the cath lab
However, careful workup for ACS should be taken for symptomatic patients with LBBB
12-Lead ECG findings
QRS > 0.12 in limb leads
Leads
Large and wide R waves — leads I, aVL, V5, and V6
Small R wave followed by deep S wave —leads II, III, aVF, V1–V3
QRS > 0.12 in limb leads
Leads
Large and wide R waves — leads I, aVL, V5, and V6
Small R wave followed by deep S wave —leads II, III, aVF, V1–V3
Large and wide R waves — leads I, aVL, V5, and V6
Small R wave followed by deep S wave —leads II, III, aVF, V1–V3
STEMI equivalents
STEMI mimics
Stable angina
Vincent's angina
Unstable angina
AVR ST elevation
T wave changes
Unstable Angina - NSTEMI Guidelines