Syncope week – Day 2 – high-risk features
Our first task is to decide whether the patient needs admission. The list is not exhaustive, but very suggestive. These features require admission and careful cardiac evaluation:
Major
New onset chest pain, headache, abdominal pain or breathlessness
Syncope during exertion or when supine!
Sudden palpitation followed by syncope
Minor
No warning symptoms or short (<10 sec) prodrome
Family history of sudden cardiac death at young age
Syncope in sitting position
Past Medical History
Known heart disease – decreased LVEF, or known coronary artery disease
Physical Exam
Unexplained BP < 90 in emergency department
GI bleed (heme positive stools)
Persistent bradycardia while awake in absence of physical training
Unexplained systolic murmur
Electrocardiogram
Acute ischemia
Mobitz II or III AV block
Slow atrial fibrillation
Bundle branch blocks, intraventricular conduction delays, Q waves
Ventricular tachycardia – sustained or non-sustained
Dysfunction of pacemaker or AICD
Type I Brugada
Prolonged QT
Source: DB's Medical Rants - Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
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