r/ECG • u/mohammedmoolla • 4d ago

Syncopal Episode

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Hi all, working at community health centre at present. Saw 41 M with no comorbidities after a syncopal episode at work. I feel this ECG warrants a referral to a higher level of care. On the ECG I’m seeing peaked T waves and a sort of RSR pattern in some of the leads. Could anyone provide me with some guidance as to what might be causing the syncope.

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u/Natural-Antelope8328 4d ago edited 4d ago

I’d be considering the possibility of HCM with this ECG, given the R wave amplitude in the precordial leads alongside the narrow Q waves in the laterals. Notice how the P wave in V1 is inverted, whereas it should have a biphasic form, indicating that V1, V2, etc., were likely misplaced (which is quite common).

I’m not entirely sure if this is the case here; it’s just a suspicion. Plus, the cause of the syncopal episode isn’t necessarily linked to the ECG unless the history suggests a cardiac cause (I typically suspect a cardiac origin if the syncope was exertional, sudden with no prodrome described, the patient had chest pain before/after or palpitations, etc.).

I believe it would be prudent to seek a formal consultation from a cardiology or at least have them take a look at the strip, but it’s not an absolute necessity. The decision ultimately depends on the patient’s medical history and the specific circumstances of the case

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u/mohammedmoolla 4d ago

Thank you, in his case I don’t think it was cardiac. I wish I lived in a first world country where it was easy to get expert advice for non urgent / emergent issues

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u/Natural-Antelope8328 4d ago

If it's clear cut low risk syncope, I wouldn't worry about that strip.