35 y/o male presents to EMS following a syncopal episode at | Figure 1

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35 y/o male presents to EMS following a syncopal episode at groundbreaking ceremony. No prior Hx of syncope or cardiac problems. No Hx or indication of seizure(s). Syncopal episode lasted approx. 30 sec and Pt reports a “surreal” feeling prior to losing consciousness. Pt reports no pain of any type. Initial vital signs approx. 10 min following episode- BP 126/80, HR 77, RR 18, GLU 73. Is this early repolarization pattern benign, or something more?

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Case 1

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responded to a 74YOM W/ Cardiac Hx nil recent issue. We were calls to a #Syncope. On arrival pt GCS15 looking well. Vitals within normal limits. Pt states nil CP, SOB or #Palpitations prior to Syncope. ECG in first picture taken at pts home. En route pt had several runs of second ECG photo. All episode of #Palpitations self reverted within 2 min. Pt remained #Asymptomatic during episodes. #Supraventricular-tachycardia vs #Ventricular-tachycardia ??

Case 2

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11yo F syncopal episode. Pt reportedly became pale and clammy while cooking with her mother. Pt’s mother states that she stated “I don’t feel good” and then had the syncopal episode which lasted approx. 5 min with no seizure activity. Upon our arrival, the Pt was lethargic and complaining of dizziness. BP: 106/60 HR:80 and regular SpO2: 99% RA breathing without difficulty BGL: 112. All of my ddx were ruled out including AEIOU-TIPS, PE, infections, dehydration/hypovolemia.

Case 3

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+~60 yr old female. Known hypertension and diabetes on treatment. Hx of syncopal episode and hitting her head. Presented with a bradycardia of 30 bpm. ECG and initial gas plus following gases post treatment.

Case 4

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thought this could be another fun one; pt early 30's calls 911 for syncope X 2. On arrival pt stable no complaints. Pt fit and active. Hx reveals syncope for months unknown cause saw numerous providers including cardiology with holter monitoring yielding no identifiable cause.

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