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Tuesday, September 20, 2022

High-Risk Syncope Mnemonic

emDOCs - September 19, 2022 - By Matthew Christensen and Kristy Schwartz
Reviewed by: Jamie Santistevan; Manpreet Singh and Brit Long
Syncope is a relatively common chief complaint in the emergency department, with a broad differential that ranges from reassuringly benign to acutely life-threatening. While there is no substitute for a thorough history and physical exam, obtaining an electrocardiogram (ECG) is a key aspect of nearly every syncope workup. Prompt recognition of high-risk ECG patterns is a critical skill for emergency medicine attendings, residents, and medical students alike. Here we introduce the mnemonic “ABCDE Left Right”, a memory aid to help EM providers quickly recall seven ECG patterns of high-risk syncope: AV block, Brugada pattern, QTc prolongation, delta waves (Wolff-Parkinson-White), epsilon waves (arrhythmogenic right ventricular cardiomyopathy), left ventricular hypertrophy, and right ventricular strain.
For a refresher on the broader approach to syncope in the emergency department and take a closer look at non-cardiac causes of syncope, see the emDocs article Syncope and Syncope Mimics.