The 6 Deadly EKG Findings in Syncope/Near-Syncope

 

Syncope demands an EKG. PAs working in EM must know this, and PA CME must teach this. Period. It’s universally agreed that this test is non-invasive, inexpensive and can save lives in syncope. But, what are we looking for? What are the sneaky findings on the EKG that can save a life? Well, there are six.

See the illustrated mnemonic HAPPY.

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(Meaning I want a HAPPY syncope patient, not a dead one!)

• Hypertrophic Obstructive Cardiomyopathy (HOCM)
• ACS
• PE
• Prolonged QT Syndrome
• Wolf Parkinson’s White
• Brugada

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In HOCM we are looking for high voltage QRS complexes with deep Q waves in the lateral leads (I/AVL/V5 and V6.)

 

With ACS we are looking for signs of ischemia.

 

With PE, if you see flipped T waves in the anterior and inferior leads, think PE.

 

With prolonged QT Syndrome we are looking at corrected QT of greater than 500ms. Look at meds.

 

WPW has three EKG characteristics: a wide complex QRS, a short PR interval and a delta wave.

 

Brugada is a syncope patient that has a RBBB and ST segment elevation in V1 and V2. This can be transient.

PA CME must be focused and effective. This mnemonic will give your the tools of retention, as in all the content at CME4LIFE.