Emergency Notes

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Syncope. 2007

1. What history and physical examination data help to risk-stratify patients with syncope?

• heart failure - higher risk of an adverse outcome.
  
• Riskmfactors: older age, structural heart disease, or a history cad
• Low risk: younger patients with syncope that is nonexertional, without history or signs of cardiovascular disease, a family history of sudden death, and without comorbidities

2. Who should be admitted after an episode of syncope of unclear cause?

• evidence of heart failure or structural heart disease.
• other factors that lead to stratification as high-risk for adverse outcome: Older age and associated comorbidities, Abnormal ECG, hct< 30 (if obtained), History or presence of heart failure, coronary artery disease, or structural heart disease

EKGs



-(short pr interval)- wpw: most common ventricular pre excitation syndrome. 1) short pr 2) prolonged qrs complex, 3) slurred upstroke of qrs complex- delta wave; can produce large r wave in v 1

-brugada syndrome: abnormalities in v1-v3: RBBB or incomplete RBBB and ST elevation; ST elevation convex upward (saddle) or "coved" (concave) morphology; need electrophysiology studies to diagnose; can develop polymorphic or monomorphic VT

-prolonged qt

-bradycardia: hr < 50 sick sinus syndrome

-prolonged pr interval: 2nd or 3rd degree av block

-Arryythmogenic Right Ventricular Dysplasia (ARVD): T Wave inversion in leads V1-V3, QRS Complex duration > 110 ms in leads V1-V3

-Abnormal QRS: Left Bundle Branch Block or Bifascicular Heart Block, QRS Duration > 120 ms, Q Waves

References:

http://www.fpnotebook.com/cv/ekg/EkgChngsInSyncpDTArhythm.htm