Epsilon wave ( figure 3), T wave inversion V1-3, +QRS in V1.Arrhythmogenic right ventricular dysplasia (ARVD).Abnormal R wave progression in chest leads.Q waves and ST changes in I, aVL, V5, V6 ( figure 2). Anomalous left coronary artery from the pulmonary artery (ALCAPA).Murmur decreases w squatting and increases w valsalva.Deep Q waves in lateral and inferior leads ( figure 1).LVH, axis deviation, ST or T wave abnormalities ( figure 1).Commotio cordis: dysrhythmia due to direct blow to the chest.WPW: delta wave, shortened PR, widened QRS.SVT: HR >220 in infants and children, >180 in older children and adolescents.2 nd/3 rd degree: neonatal lupus syndrome, congenital heart block, acquired- infectious myocarditis (lyme), RHD, dig tox, cardiac surgery.1 st degree usually incidental, 2 nd degree Mobitz may also be normal.medications: tricyclic antidepressants, antipsychotics, antibiotics (macrolides), organophosphates, antihistamines, antifungals.associated congenital syndromes: Romano-Ward and Jervell-Nielsen-Lange (assoc w FH of deafness).QTc = QT/sqrt(R-R) measure beginning of QRS to end of T wave in leads II, V5.physical features associated w cardiac or neuro disease (eg Marfan habitus, café-au-lait spots, wooly hair).cardiac auscultation supine and standing.FH of sudden death, long QT, sensorineural hearing loss.The key to the ED evaluation of pediatric syncope is using the history, physical, and ECG to exclude serious pathology. Syncope is a sudden transient loss of consciousness and postural tone followed by complete spontaneous recovery caused by acute hypoperfusion of either both cerebral hemispheres or the brainstem (RAS).
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