Oct 17, 2022
Contributor: Travis Barlock, MD
Educational Pearls:
- An EKG should be obtained quickly after a syncopal event to identify possible life-threatening causes such as ischemia and arrhythmia
- WOBBLER is a good mnemonic for remembering additional EKG findings to look for in syncope
- Wolff-Parkinson-White (WPW)
- Check for delta wave on QRS
- Obstructed AV node
- Any potential heart blocks
- Brugada syndrome
- Na channel blockade that can cause ST elevations in anterior leads
- Bifascicular block
- Conduction blockade in two of the three fascicles increases risk of complete heart block
- Left Ventricular Hypertrophy (LVH)
- Can be a sign of HOCM (younger patients) or aortic stenosis (older patients)
- Epsilon waves
- Positive deflections after the QRS that is seen in arrhythmogenic right ventricular dysplasia
- Repolarization abnormalities
- Prolonged/shortened QT segments
References
Martow E, Sandhu R. When Is Syncope Arrhythmic? Med Clin North Am. 2019;103(5):793-807.
Solbiati M, Dipaola F, Villa P, et al. Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study. Acad Emerg Med. 2020;27(1):15-23.
Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD
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