Wednesday, April 8, 2015


Dr Smith´s ECG Blog - April 8, 2015
in patients who truly have syncope as the chief complaint (It's not seizure, and it's not abdominal pain, chest pain, hypotension, dyspnea, headache, and VS and rhythm are normal in the ED), and after ruling out the bleeding, stroke, and obstructive problems, we’re left with these worrisome predictors:
  1. Age greater than 65
  2. History of cardiovascular disease, especially Heart Failure, or structural heart disease (including, or especially, valvular disease)
  3. No prodrome
  4. Syncope with exertion, or preceded by palpitations, or supine
  5. Hemoglobin less than 10
  6. Also consider family history of unexplained sudden death, especially if at age less than 40
  7. Abnormal ECG, as above.
Workup (Smith opinion from literature)
Always evaluate with:
  1. Good History and Physical exam, including 
    1. orthostatic vitals
    2. heart auscultation (aortic stenosis); 
    3. FHx of sudden death.
  2. ECG
Consider in some patients:
  • Ultrasound of aorta, of heart
  • Abd free fluid (FAST exam)
  • Hgb
  • Urine Pregnancy Test in women of child bearing age
  • BNP
  • Troponin
  • d dimer"