Syncope
Red flags
The only question that matters: is this cardiac? Cardiac syncope ~30% 1-yr mortality; reflex syncope ~0%
History red flags
- Exertional syncope (during, not after) - AS, HOCM, anomalous coronary, PAH
- Supine or seated onset
- No prodrome / sudden onset ("like a switch")
- Preceded by palpitations or chest pain
- Family history of SCD <40yr or inherited cardiac disease
- Known structural heart disease or prior MI
ECG red flags
- Any bifascicular block, QRS >=120 ms, Mobitz II or 3rd degree AV block
- Sinus brady <40 awake, or pauses >3 s
- Pre-excitation (short PR + delta wave)
- QTc >460 ms (long) or <340 ms (short)
- Brugada type 1 coved ST elevation V1-V2
- Epsilon wave / T inversion V1-V3 (ARVC)
- Q waves, LVH, ventricular ectopy
Examination / context red flags
- Systolic murmur (AS, HOCM)
- Hypotension (SBP <90), unexplained anaemia
- Syncope causing injury or occurring while driving
- Syncope in a known HF / low EF patient
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