Syncope Approach

DDx of Life Threats

Cardiac/Vascular

Rhythm – Brady/block, long QT, short QT, VT,  WPW, ARVD, consider underlying elyte abnormality

Structural – HCM, Severe AS (e.g. aortic stenosis and “sub-aortic stenosis”

Ischemia

Tamponade

Dissection

PE

Neurologic

SAH

CVA/TIA (weird)

Hemorrhage

GI

Ectopic pregnancy

AAA

 

Approach

  • All patients on the monitor early
  • Low threshold to apply defib pads right away
  • Consider IV/O2

Careful history

Consider seizure

Family history including sudden deaths, drowning etc.

Workup

ECG – Everyone, assess for:

  • Too fast?
    • VT, TdP, WPW/afib
  • Too slow?
    • CHB or Mobitz II block
    • Sinus brady, sinus pauses, sick sinus
  • Syncope syndromes
    • WPW
    • Long QT (>500)
    • Short QT (<320)
    • Brugada
    • ARVD – RVH, epsilon waves
    • HOCM (voltage criteria for LVH, precordial TWI, dagger Q’s
  • Pump failure
    • MI
    • PE
    • Tamponade/effusion
  • Electrical problems
    • Hypo/hyperkalemia
    • Pacemaker failure

Labs other

  • Urine pregnancy in all women
  • Hgb, elytes, cardiac/aorta US, CT (head, PE etc.) as guided by H&P