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 syncope
Minor
- No warning symptoms or short (<10 sec) prodrome
- Family history of sudden cardiac death at young age
- Syncope in sitting position
Past Medical History
- Known heart disease – decreased LVEF, or known coronary artery disease
Physical Exam
- Unexplained BP < 90 in emergency department
- GI bleed (heme positive stools)
- Persistent bradycardia while awake in absence of physical training
- Unexplained systolic murmur
Electrocardiogram
- 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 QT