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I’m not sure about you, but I seem to be seeing more patients with syncope than ever before. This year at EMCORE, I spent over an hour going into the ECG’s of syncope.

Syncope is difficult because it is a symptom, not a condition and it’s up to us to find the cause. My approach is to determine if it is cardiac or not? If it is cardiac, those patients are at an increased risk of mortality and morbidity. If it isn’t cardiac, then I’m less concerned about neuro-cardiogenic syncope i.e.., vaso vagal, what I am concerned about is not to miss the other big causes which include;

AAA,  thoracic aortic dissection,  pulmonary embolism,  subarachnoid haemorrhage or other intracranial bleed.

The ECG has a less than 5% yield(Ann Emerg Med 1984) in these cases, however a normal ECG lowers the likelihood of arrhythmia as a cause of syncope. The reality is, that no other screening test has been shown to make any great difference.

In view of this, I came up with a simple memory device, so we can remember what we need to look for in the ECG, when patients with syncope present. Will it pick up everything? Nothing does, but it will pick up the big things. Here is the formula. For those that have the ECG in 20 Seconds USB, you will also have a password emailed, that allows you to watch the full 1 hour video.

Acute Coronary Syndrome

 Arrhythmogenic Right Ventricular Dysplasia

Blocks– Bundle Branch blocks, 2nd and 3rd degree blocks



Wolf Parkinson White Syndrome

Long QT Syndrome




Peter Kas

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