Most syncope in the emergency department is reflex or orthostatic. A few features point to an arrhythmic cause and change the plan — these are the patients in whom monitoring earns its place.
- Syncope during exertion or while lying down
- Palpitations immediately before the faint, or no prodrome at all
- Known structural heart disease or heart failure
- Abnormal ECG: conduction block, long QT, Brugada pattern, pre-excitation
- Family history of sudden death under 40
Why it matters
These features, not the lack of an explanation, are what make an arrhythmic cause likely.
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