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

In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/

Podcast 821: EKGs in Syncope