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 syncopeMinor
No warning symptoms or short (<10 sec) prodrome Family history of sudden cardiac death at young age Syncope in sitting positionPast Medical History
Physical Exam
Unexplained BP < 90 in emergency department GI bleed (heme positive stools) Persistent bradycardia while awake in absence of physical training Unexplained systolic murmurElectrocardiogram
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 QTShare this Post