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

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