ECG Exercise 5 - Syncope

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Written by Eric Tang MD

Last updated 8/15/24

Assume every patient is presenting with syncope.

Click on image for full screen view (only on computer).

ECG 1

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments or T waves?

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In the context of syncope, is this ECG concerning? if so, why?

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Source 281

ECG 2

Additional clinical context: recently diagnosed lung mass p/w syncope preceded by a week of abdominal pain, lethargy, weight loss, flank pain

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals P waves, QRS complexes, ST segments or T waves?

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In the context of syncope, is this ECG concerning? if so, why?

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Source: LIFTL

ECG 3

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals P waves, QRS complexes, ST segments or T waves?

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In the context of syncope, is this ECG concerning? if so, why?

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Source - 73

ECG 4

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals P waves, QRS complexes, ST segments or T waves?

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In the context of syncope, is this ECG concerning? if so, why?

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Source: 915, 363

ECG 5

Additional info: ingested an entire bottle of her prescribed medications 6 hrs ago

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Estimate the heart rate (slow, fast, or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments, or T waves?

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In the context of syncope, is this ECG concerning? If so, why?

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Your attending orders a medication and gets a repeat ECG (below). What medication was given?

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Source: 359

ECG 6

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments, or T waves?

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In the context of syncope, is this ECG concerning? If so, why?

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Source: 208

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More than half way there. Take a break and recall the ECG differential diagnosis for syncope using the ABCDE HI mnemonic.

ECG 7

Additional info: syncope preceded by chest pain and is on OCPs.

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments, or T waves?

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In the context of syncope, is this ECG concerning? If so, why?

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Source 308

ECG 8

Additional info: patient is 18 years old with 3 prior visits for syncope

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments, or T waves?

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In the context of syncope, is this ECG concerning? If so, why?

ECG 9

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals, P waves, QRS complexes, ST segments, or T waves?

‣

In the context of syncope, is this ECG concerning? If so, why?

ECG 10

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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.

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Any concerning intervals QRS complexes, P waves, ST segments or T waves?

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In the context of syncope, is this ECG concerning?

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Source - 42

Post Exercise Questions

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Q1: Recite the ECG differential diagnosis for syncope using the ABCDE HI mnemonic.

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Q2: What electrolyte abnormality can shorten QTc?

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Q3: What electrolyte abnormality can lengthen the QTc:

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Q4: What are the ECG features of an abnormal q wave?

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Q5: What is the differential diagnosis for a tall R wave in V1?