CC12 Cardiology MRCEM syllabus

Deadly cardiac arrhythmias - rare but important differential in investigating Syncope

important history taking

before:

Relationship to exercise
No warning symptoms
Higher incidence of injuries
Pale during event
Rapid recovery
Previous history of blackouts, shortness of breath or chest tightness during exertion, or palpitations
Family history of young death

etiologies

HOCM
- deep narrow Q waves in lateral >> inferior leads
- high LV voltage
- L atrial enlargement
arrhythmogenic RV cardiomyopathy
- Epsilon wave
- TWI V1-3; prolonged S-wave upstroke V1-3
- QRS widening V1-3
Wolff-Parkinson-White syndrome
- sinus with short PR interval
- Broad QRS, slurred upstroke = delta wave
- Tall R waves, inverted T waves V1-3
- negative delta wave in aVL, looks like Q waves
Brugada
- coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave
Long QT
- QT interval divided by sqrt R-R interval
Catecholaminergic Polymorphic Ventricular Tachycardia
- exercise or emotion-induced syncope or 'fit'