Syncope electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Generally, the ECG of individuals with syncope is normal. However, ECG may be remarkable for an arrhythmia. The arrhythmia may be seen on the EKG include sinus bradycardia <40 beats/min or repetitive sinoatrial blocks or sinus pauses > 3s, Mobitz II 2nd or 3rd-degree atrioventricular block, alternating left and right bundle branch block, rapid paroxysmal supraventricular tachycardia, ventricular tachycardia, and pacemaker malfunction with cardiac pauses.
Electrocardiogram
Generally, the ECG of individuals with syncope is normal. However, ECG may be remarkable for an arrhythmia. The following arrhythmia may be seen on the EKG:[1][2]
- Sinus bradycardia <40 beats/min or repetitive sinoatrial blocks or sinus pauses > 3s
- Mobitz II 2nd or 3rd-degree atrioventricular block
- Alternating left and right bundle branch block
- Rapid paroxysmal supraventricular tachycardia
- Ventricular tachycardia
- Pacemaker malfunction with cardiac pauses
An ECG may be helpful in the diagnosis of syncope. Findings on an ECG suggestive of cardiovascular syncope include:
- Bifascicular block (defined as either left bundle branch block or right bundle branch block combined with left anterior or left posterior fascicular block)
- Other intraventricular conduction abnormalities (QRS duration > 0.12 s)
- Mobitz I second degree atrioventricular block
- Asymptomatic sinus bradycardia (<50 beats/min) in the absence of negatively chronotropic medications use
- Pre-excited QRS complexes
- QT prolongation
- Right bundle branch block pattern with ST elevation in leads V1-V3 (Brugada syndrome)
- Negative T waves in right precordial leads, epsilon waves and ventricular late potentials suggestive of arrhythmogenic right ventricular dysplasia
- Q waves suggesting previous myocardial infarction
Example
Shown below is an EKG of an elderly man with syncope.
2017 ACC/AHA/HRS Guideline
| Class I |
| "1. ECG is the first evaluation for patients presented with syncope (Level of Evidence: B)" |
References
- ↑ "Guidelines on Management (diagnosis and treatment) of syncope ? update 2004". Europace. 6 (6): 467–537. 2004. doi:10.1016/j.eupc.2004.08.008. ISSN 1099-5129.
- ↑ Puppala, Venkata Krishna; Dickinson, Oana; Benditt, David G. (2014). "Syncope: Classification and risk stratification". Journal of Cardiology. 63 (3): 171–177. doi:10.1016/j.jjcc.2013.03.019. ISSN 0914-5087.
- ↑ Shen, Win-Kuang; Sheldon, Robert S.; Benditt, David G.; Cohen, Mitchell I.; Forman, Daniel E.; Goldberger, Zachary D.; Grubb, Blair P.; Hamdan, Mohamed H.; Krahn, Andrew D.; Link, Mark S.; Olshansky, Brian; Raj, Satish R.; Sandhu, Roopinder Kaur; Sorajja, Dan; Sun, Benjamin C.; Yancy, Clyde W. (2017). "2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 136 (5). doi:10.1161/CIR.0000000000000499. ISSN 0009-7322.