Thread by @ManualOMedicine

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💠 Pearls in Syncope ECG Interpretation.

➡️ In the patient with syncope, the ECG should be scrutinized for signs of Ischemia, Bradydysrhythmias, Tachydysrhythmias, and Conduction delays.

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➡️ Additional critical diagnoses to consider that can be detected with ECG:

👉Ventricular Preexcitation (WPW)
👉Brugada syndrome
👉Long or short QT syndromes
👉Hypertrophic Cardiomyopathy
👉Arrhythmogenic right ventricular dysplasia
👉Catecholaminergic polymorphic VT

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➡️ Ventricular Preexcitation (WPW)

👉 PR segment < 120 ms
👉 QRS complex > 110 ms
👉 Slurred upstroke of the initial part of the R wave (delta wave)
➖ Type A: delta wave in all precordial leads, R > S in lead V1
➖ Type B: negative delta waves in leads V1 and V2

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➡️ Brugada Syndrome
👉Type 1
➖Coved ST elevation
➖>2 mm of ST elevation in 2 or more precordial leads (V1 to V3) and negative T wave
👉Type 2
➖Saddle back ST elevation
➖>2 mm of ST elevation in 2 or more precordial leads
👉Type 3
➖Either type <2 mm ST elevation

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➡️ Long QT Syndrome

👉 Prolonged if QTc > 440 ms in men or >460 ms in females
👉 Increased risk of dysrhythmias when the QTc > 500 ms

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➡️ Short QT Syndrome

👉 Shortened if QTc < 330 ms in males or <340 ms in females
👉 Short, or absent, ST-segment with peaked appearance of the T wave
👉 Etiologies to consider include congenital shortening, digoxin toxicity, and hypercalcemia.

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➡️ Hypertrophic cardiomyopathy

👉 Deep Q waves in the lateral (I, aVL, V5-V6) and inferior (II, III, aVF) leads
👉 Left ventricular hypertrophy (LVH)
👉 Left atrial enlargement

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➡️ Arrhythmogenic Right Ventricular Dysplasia (ARVD)

👉 Epsilon wave (small positive deflection at end of QRS complex)
👉 T-wave inversions in V1 to V3
👉 Prolonged QRS in V1 to V3 (100 to 120 ms)
👉 Slurred S-wave upstroke in V1 to V3 (50 to 55 ms)

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➡️ Catecholaminergic Polymorphic VT

👉 ECG is typically normal at rest.
👉 Exercise classically induces VT from adrenergic activation.
👉 Bidirectional tachycardia
👉 Ventricular ectopy is often noted when the heart rate increases above 100 beats per minute.

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