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