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

  1. New onset chest pain, headache, abdominal pain or breathlessness
  2. Syncope during exertion or when supine!
  3. Sudden palpitation followed by syncope

Minor

  1. No warning symptoms or short (<10 sec) prodrome
  2. Family history of sudden cardiac death at young age
  3. Syncope in sitting position

Past Medical History

  1. Known heart disease – decreased LVEF, or known coronary artery disease

Physical Exam



  1. Unexplained BP < 90 in emergency department
  2. GI bleed (heme positive stools)
  3. Persistent bradycardia while awake in absence of physical training
  4. Unexplained systolic murmur

Electrocardiogram

  1. Acute ischemia
  2. Mobitz II or III AV block
  3. Slow atrial fibrillation
  4. Bundle branch blocks, intraventricular conduction delays, Q waves
  5. Ventricular tachycardia – sustained or non-sustained
  6. Dysfunction of pacemaker or AICD
  7. Type I Brugada
  8. Prolonged QT

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