Syncope
Summary: <br> 6 EKG Findings. 6 Risk Factors. 6 Mimics.<br> <br> <br> <br> Step 1: Get an EKG<br> <br> <br> <br> * This is the only “required” test for a patient with syncope* Other common tests* CBC* Evaluate for anemia* hCG* If patient might be pregnant<br> <br> <br> <br> Step 2: Look For 6 High Risk EKG Patterns<br> <br> <br> <br> * 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)<br> <br> <br> <br> Step 3: Ask the 6 High Risk Historical Questions<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 4: Consider 6 Deadly Syncope Mimics<br> <br> <br> <br> * 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<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * QT Intervals<a href="https://litfl.com/qt-interval-ecg-library/"> (LITFL)</a>* Brugada Syndrome <a href="https://litfl.com/brugada-syndrome-ecg-library/">(LITFL)</a>* Right Heart Strain <a href="https://litfl.com/right-ventricular-strain-ecg-library/">(LITFL)</a>* Delta Wave <a href="https://litfl.com/delta-wave-ecg-library/">(LITFL)</a>* Epsilon Wave <a href="https://litfl.com/epsilon-wave-ecg-library/">(LITFL)</a><br>
