The effectiveness of electrocardiographic findings in diagnosis and treatment of patients presenting to the emergency department with syncope

Objective: Syncope is a spontaneous loss of consciousness and postural tone that develops in a short time as a result of temporary impairment of brain blood flow. Syncope is a common medical problem in the emergency department and can result in a wide range of diseases ranging from very simple causes to life-threatening arrhythmias. In this study, we aimed to determine the relationship between ECG findings and syncope in adult patients who presented to the emergency department with syncope, to determine the risk factors of syncope and to investigate its effectiveness in emergency diagnosis and treatment. Material and Method: This prospective study was started after receiving ethics board approval, and 150 patients who were admitted to Cukurova University Emergency Department Adult Emergency Clinic with the complaints of syncope between December 2017 and March 2019 were included in the study. 12-lead ECGs at 25mm / sec were recorded and the patients were monitored. Heart rate, PR, QRS, QT intervals were calculated on ECG. Rhythm analysis, presence of branch block, AV-complete block, ischemia findings, WPW syndrome, Brugada syndrome and ARVD were evaluated in ECG. Syncope / seizure discrimination was performed in the patients included in the study. Patients who were found to have seizures were excluded from the study. Syncope types of the patients were determined. In addition, age, gender, underlying diseases, additional complaints, syncope duration, vital signs, syncope types, ECG and laboratory data, duration of emergency stay, emergency diagnosis, discharge and hospitalization were recorded. Statistical analysis of the study was performed by entering the data obtained to the SPSS program. Findings: A total of 150 patients, 72 (48,0%) male and 78 (52%) female, were included in study. In our study, when the ECG results of the patients were examined, the number of patients with arrhythmia was 18 (22%), complete branch block was 5 (3,3%), patients with ischemic findings was 5 (3,3%), the patients with Brugada syndrome was 2 (1,3%) and the patient with ARVD was 1 (0,7%). A statistically significant relationship was found between patients 65 years and older and those who had QRS, QT length, arrhythmia, bundle branch block and AV-complete block in their ECG. Similarly, there was a statistically significant relationship between patients with syncope type cardiac syncope and those with QRS, QT length, arrhythmia, branch block and AV-complete block on their ECG. A statistically significant relationship was found between the patients who had QT length, arrhythmia, branch block, AV-complete block and ischemia findings on ECG and hospitalized patients. Conclusion: In patients presenting to the emergency department with syncope, history and a good physical examination and 12-lead ECG are very important for early diagnosis and rapid treatment. In the presence of abnormal ECG findings (arrhythmia, QRS width, QT length, bundle branch block, AV-complete block) and in patients with additional disease, the incidence of syncope increases and there is no significant relationship between abnormal ECG findings and syncope recurrence. It was determined that the probability of VT increased if syncope duration was less than 5 seconds. Keywords: Emergency Medicine, Syncope, ECG findings