Syncope

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6 EKG Findings. 6 Risk Factors. 6 Mimics.

Step 1: Get an EKG

• This is the only “required” test for a patient with syncope
• Other common tests
  • CBC
    • Evaluate for anemia
  • hCG
    • If patient might be pregnant

Step 2: Look For 6 High Risk EKG Patterns

• Mnemonic: QT-BRIDE
  • QT prolongation
    • Especially QTc >500
  • Brugada pattern
  • Right heart strain
    • Tachycardia
    • S1Q3T3
    • Inverted T waves precordial leads
  • Ischemic changes
    • ST segment elevation/depression
    • T wave inversion
  • Delta waves
    • Seen in Wolf-Parkinson White (WPW)
  • Epsilon waves
    • Seen in arrhythmogenic right ventricular dysplasia (ARVD)

Step 3: Ask the 6 High Risk Historical Questions

• Mnemonic: CHESS +1
  • Cardiac history
    • CHF
    • Structural heart disease
  • Hematocrit <30%
  • “Elderly”
  • Shortness of Breath
  • Systolic BP <90
  • (+1) Family history of sudden cardiac death

Step 4: Consider 6 Deadly Syncope Mimics

• 15% of the following diseases reportedly present as “syncope”
  • AKA “Rule of 15s”
• Subarachnoid hemorrhage
• Myocardial infarction
• Pulmonary embolism
• Aortic dissection
• Abdominal aortic aneurysm
• Perforated GI
  • Ulcers
  • Ectopics

Additional Reading

• QT Intervals (LITFL)
• Brugada Syndrome (LITFL)
• Right Heart Strain (LITFL)
• Delta Wave (LITFL)
• Epsilon Wave (LITFL)