Syncope electrocardiogram: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Syncope}} | {{Syncope}} | ||
{{CMG}} {{AE}} {{Sahar}} | |||
{{CMG}} | |||
==Overview== | ==Overview== | ||
Electrocardiogram | Generally, the [[ECG]] of individuals with syncope is normal. However, [[ECG]] may be remarkable for an [[arrhythmia]]. The [[arrhythmia]] may be seen on the [[EKG]] include [[sinus bradycardia]] <40 beats/min or repetitive sinoatrial blocks or [[Sinus pause|sinus pauses]] > 3s, [[Mobitz II]] 2nd or [[Third degree AV block|3rd-degree atrioventricular block]], alternating [[Left bundle branch block|left]] and [[right bundle branch block]], rapid [[paroxysmal supraventricular tachycardia]], [[ventricular tachycardia]], and pacemaker malfunction with cardiac pauses. | ||
==Electrocardiogram== | |||
Generally, the [[ECG]] of individuals with syncope is normal. However, [[ECG]] may be remarkable for an [[arrhythmia]]. The following [[arrhythmia]] may be seen on the [[EKG]]:<ref>{{cite journal|title=Guidelines on Management (diagnosis and treatment) of syncope ? update 2004|journal=Europace|volume=6|issue=6|year=2004|pages=467–537|issn=10995129|doi=10.1016/j.eupc.2004.08.008}}</ref><ref name="PuppalaDickinson2014">{{cite journal|last1=Puppala|first1=Venkata Krishna|last2=Dickinson|first2=Oana|last3=Benditt|first3=David G.|title=Syncope: Classification and risk stratification|journal=Journal of Cardiology|volume=63|issue=3|year=2014|pages=171–177|issn=09145087|doi=10.1016/j.jjcc.2013.03.019}}</ref> | |||
*[[Sinus bradycardia]] <40 beats/min or repetitive [[sinoatrial blocks]] or [[Sinus pause|sinus pauses]] > 3s | |||
*[[Mobitz II]] 2nd or [[Third degree AV block|3rd-degree atrioventricular block]] | |||
* Alternating [[Left bundle-branch block|left]] and [[right bundle branch block]] | |||
* Rapid [[paroxysmal supraventricular tachycardia]] | |||
*[[Ventricular tachycardia]] | |||
* Pacemaker malfunction with cardiac pauses | |||
An [[ECG]] may be helpful in the diagnosis of syncope. Findings on an ECG suggestive of [[cardiovascular]] syncope include: | |||
*[[Bifascicular block]] (defined as either [[left bundle branch block]] or [[right bundle branch block]] combined with [[Left anterior fascicular block|left anterior]] or [[left posterior fascicular block]]) | |||
* Other intraventricular conduction abnormalities (QRS duration > 0.12 s) | |||
*[[Mobitz I|Mobitz I second degree atrioventricular block]] | |||
* Asymptomatic [[sinus bradycardia]] (<50 beats/min) in the absence of negatively [[chronotropic]] [[medications]] use | |||
* Pre-excited QRS complexes | |||
*[[QT prolongation]] | |||
*[[Right bundle branch block]] pattern with [[ST elevation]] in leads V1-V3 ([[Brugada syndrome]]) | |||
* Negative [[T waves]] in right [[precordial leads]], [[epsilon waves]] and [[ventricular]] late potentials suggestive of [[arrhythmogenic]] [[right ventricular]] dysplasia | |||
*[[Q waves]] suggesting previous [[myocardial infarction]] | |||
== | ===Example=== | ||
Shown below is EKG | Shown below is an [[EKG]] of an elderly man with syncope. | ||
[[Image:Syncopesp.jpg|center|500px]] | [[Image:Syncopesp.jpg|center|500px]] | ||
=== | ==2017 ACC/AHA/HRS Guideline == | ||
<ref name="ShenSheldon2017">{{cite journal|last1=Shen|first1=Win-Kuang|last2=Sheldon|first2=Robert S.|last3=Benditt|first3=David G.|last4=Cohen|first4=Mitchell I.|last5=Forman|first5=Daniel E.|last6=Goldberger|first6=Zachary D.|last7=Grubb|first7=Blair P.|last8=Hamdan|first8=Mohamed H.|last9=Krahn|first9=Andrew D.|last10=Link|first10=Mark S.|last11=Olshansky|first11=Brian|last12=Raj|first12=Satish R.|last13=Sandhu|first13=Roopinder Kaur|last14=Sorajja|first14=Dan|last15=Sun|first15=Benjamin C.|last16=Yancy|first16=Clyde W.|title=2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society|journal=Circulation|volume=136|issue=5|year=2017|issn=0009-7322|doi=10.1161/CIR.0000000000000499}}</ref> | |||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background: | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
|bgcolor=" | | bgcolor="LightGreen"| <nowiki>"</nowiki>'''1.''' ECG is the first evaluation for patients presented with [[syncope]] ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
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{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Latest revision as of 16:31, 20 January 2021
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Syncope Microchapters |
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Syncope electrocardiogram On the Web |
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American Roentgen Ray Society Images of Syncope electrocardiogram |
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Risk calculators and risk factors for Syncope electrocardiogram |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Generally, the ECG of individuals with syncope is normal. However, ECG may be remarkable for an arrhythmia. The arrhythmia may be seen on the EKG include sinus bradycardia <40 beats/min or repetitive sinoatrial blocks or sinus pauses > 3s, Mobitz II 2nd or 3rd-degree atrioventricular block, alternating left and right bundle branch block, rapid paroxysmal supraventricular tachycardia, ventricular tachycardia, and pacemaker malfunction with cardiac pauses.
Electrocardiogram
Generally, the ECG of individuals with syncope is normal. However, ECG may be remarkable for an arrhythmia. The following arrhythmia may be seen on the EKG:[1][2]
- Sinus bradycardia <40 beats/min or repetitive sinoatrial blocks or sinus pauses > 3s
- Mobitz II 2nd or 3rd-degree atrioventricular block
- Alternating left and right bundle branch block
- Rapid paroxysmal supraventricular tachycardia
- Ventricular tachycardia
- Pacemaker malfunction with cardiac pauses
An ECG may be helpful in the diagnosis of syncope. Findings on an ECG suggestive of cardiovascular syncope include:
- Bifascicular block (defined as either left bundle branch block or right bundle branch block combined with left anterior or left posterior fascicular block)
- Other intraventricular conduction abnormalities (QRS duration > 0.12 s)
- Mobitz I second degree atrioventricular block
- Asymptomatic sinus bradycardia (<50 beats/min) in the absence of negatively chronotropic medications use
- Pre-excited QRS complexes
- QT prolongation
- Right bundle branch block pattern with ST elevation in leads V1-V3 (Brugada syndrome)
- Negative T waves in right precordial leads, epsilon waves and ventricular late potentials suggestive of arrhythmogenic right ventricular dysplasia
- Q waves suggesting previous myocardial infarction
Example
Shown below is an EKG of an elderly man with syncope.
2017 ACC/AHA/HRS Guideline
| Class I |
| "1. ECG is the first evaluation for patients presented with syncope (Level of Evidence: B)" |
References
- ↑ "Guidelines on Management (diagnosis and treatment) of syncope ? update 2004". Europace. 6 (6): 467–537. 2004. doi:10.1016/j.eupc.2004.08.008. ISSN 1099-5129.
- ↑ Puppala, Venkata Krishna; Dickinson, Oana; Benditt, David G. (2014). "Syncope: Classification and risk stratification". Journal of Cardiology. 63 (3): 171–177. doi:10.1016/j.jjcc.2013.03.019. ISSN 0914-5087.
- ↑ Shen, Win-Kuang; Sheldon, Robert S.; Benditt, David G.; Cohen, Mitchell I.; Forman, Daniel E.; Goldberger, Zachary D.; Grubb, Blair P.; Hamdan, Mohamed H.; Krahn, Andrew D.; Link, Mark S.; Olshansky, Brian; Raj, Satish R.; Sandhu, Roopinder Kaur; Sorajja, Dan; Sun, Benjamin C.; Yancy, Clyde W. (2017). "2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 136 (5). doi:10.1161/CIR.0000000000000499. ISSN 0009-7322.