ECG Case 028
30-year old Thai male presenting with syncope. Describe the ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
ECG Findings
The patient is in sinus rhythm with no evidence of dysrhythmia or AV block.
The QT interval is normal and there is no evidence of WPW syndrome, HOCM or ARVD.
There is a characteristic pattern of abnormalities in V1-2:
- RSR’ pattern / partial RBBB
- ST elevation with a “coved” morphology
- Inversion of the terminal portion of the T wave
In a patient presenting with syncope, this ECG is diagnostic of the Brugada syndrome.
CLINICAL PEARLS
Syncope ECG Checklist
When faced with a patient presenting with syncope, systematically assess the ECG for the following abnormalities (click each item for details):
Too Fast?
- Any abnormal tachycardia e.g. ventricular tachycardia, TdP
Too Slow?
- AV block e.g. Mobitz II or complete heart block
- Sinus bradycardia or sinus pauses
Pump Failure
- Evidence of myocardial ischaemia
- Evidence of pulmonary embolism
Syncope Syndromes
- WPW — delta wave, short PR
- Long QT syndrome? — QT > 500 ms
- Short QT syndrome? — QT < 320 ms
- Brugada syndrome? — RSR’ with STE in V1-3
- HOCM — voltage criteria for LVH, precordial TWI, “dagger” Q waves
- ARVD — signs of RVH, Epsilon waves
Electrical Problems
- Electrolyte abnormality e.g. hypokalaemia or hyperkalaemia
- Evidence of pacemaker failure
TOP 100 ECG Series
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |
MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner