Syncope

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

2 Comments

  1. Natalie

    Hi! I am a PA student a week into my EM rotation and have just discovered your podcasts/websites. They have been so helpful is providing a framework for the approach to various complaints- thank you!!

    • Zack

      Awesome! I’m glad you are finding the content useful for your rotation. Enjoy your shift!

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