THANKS!!! Summary: With syncope patient and ECG evaluation Look for the "common stuff" - 1) Ischemia - 2) Dysarytmias and the the rare stuff (that you need to look for consciously) - No 1: HOCM - High voltage + deep-narrow (non ischemic) q-waves (especially lateral leads: I, aVL, V5, V6) - No 2: Brugada - V1-V2 look for downsloaping ST-elevations (Coved type) > Saddle type . Look in V1+V2 (forget V3; forget about subtypes of brugada - neither are helpfull) - No 3: WPW - if "normal ECG": look for short PR interval and delta-waves in ALL leads (might be missing in some); if takykardia: "snow flake" (every QRS looks a little different), HR around 300, wide QRS. Don't use AV-nodal blockers - No 4: Prolonged QTc >500 msek
A note about the computer always correctly interpreting the QT. I had a patient that it interpreted as having approximately 540ms QT and when I looked at the ekg I knew that couldn't be correct, it was around 320ms. The t waves were very flat. I measured from the qrs to the next p wave and got around 540ms. The computer missed the t wave because it was so flat and counted the next p wave as the T. So they're not 100%.
I got extremely dizzy, lied down, and had a 4.5 min seizure-like episode. I was conscious for the episode (although maybe not the entire 4.5m) and with the exception of dizziness, made a complete recovery in less than 1 min. I couldn't move, couldn't yell, could barely whisper, couldn't swallow, had stridor. Your talk was sufficient for me to confirm in my own ECG that I lacked the often overlooked conditions of HCM, Brugada, Arterial fibrillation with WPW, and Long QT brain Hyperperfusion. Knowing what to look for and what is most often missed is of great comfort to this patient. For those of us following along at home who are not doctors, (I know this is not your audience) it would be helpful if you painted the part of the trace you were referring to in red at the same time as the condition is revealed. I also assume some could benefit from labeling the waveform with QRST.
I am extremely worried about an episode i had yesterday,i would definitely need some help or advice but the informations i can provide are very fragmatery but i will give it a try.First i have to say i deal with severe stress and the possibility having Brugada syndrome dispite having multiple heart tests and no family history which has lead to sleep to me.Anyway i was in bed tired at 4:30 plus in the morning and was on my phone specifically on UA-cam.Now we jump at 10 in the morning when i woke up and immediately upon i did i had the perception that at some point earlier in the night i found myself under the blanket touching my heart and feeling 2 fast heart beats although it could be my idea(Don't recall shortness of breathing, chest pain or Dizziness but i don't know about confusion or palpitations plus i stayed laying in bed rather having an intense reaction).The other 2 things i remember very clearly were me being on my phone in my right side and under the blanket at(5:40) tired and the other thing was my sister coming into my room taking something and closing the light while only my head was out of the blanket (I don't know which of the 2 events occurred first). Finally at some point it seems like my mother came in and took my phone and said i was snoring. I want to add upon waking up at 10:00 o'clock and having the perception of that event one side of my mind was saying that it was something serious while another side said it wasn't and the very next thing was a headache from stress plus the more i try now to remember the less i can and the event feels even more disoriented although it could have occurred while i was in my phone because anyway i was very tired the whole time.I am very sorry i can provide very fragmatery informations but could have been recovery from arrithmogenetic syncope in rest ?
I am a Pt. Female 41 . I was diagnosed with vasovagal Syncope this morning. It all started on Nov. 24th in the kitchen. I suddenly got very light headed and freezing cold. I had to lay down. I felt horrible the entire day and couldn't get warm. Several more episodes occurred until the worst one while I was driving on Dec. 2nd when i almost crashed into oncoming traffic. I went to ER and had elevated d dimer and abnormal T wave. I was admitted and had Bradycardia with a high of 51 and low of 37 with a BP of 102/67. I have "athletes heart" even though I'm not an athlete. Otherwise normal heart with slight bit of atrial regurgitation. Anyway. I'm still S B with average of 51 bpm. The Cardiologist is telling me to wear compression hose and to lie down right away if feeling an episode. Or to pull over when driving. I feel like I'm going to end up hurting myself or someone else if I keep driving. But he says to live my life. I don't feel better immediately after these things happen to me. I have super slow pounding in my chest after and I feel confused and dazed for hours after. Should I trust his opinion or seek another opinion?
This is gold. Solid review, and excellent take-home points. At least one class of ACPs will have these on the road. Thanks again. PS - I'm a huge fan of yours and so very thankful that you take the time to educate. Cheers
I'm old and living with heart racing & fainting , been put through the mill for months, still zero help. I am now dizzy 80% of the time. Have all kinds of tests including 2 weeks heart monitor. No diagnosis. Not fun.
I have nuerocardiogenic syncope. My electrocardiologist has been wanting me to get a pacemaker for the last year. I've been avoiding it because I'm only 40. Now I'm considering it.
My dad has obstructive HC and last week had syncope for the first time. He refused to go to the doctor or hospital at the time. This video helped me anyway as a lay person.
I have problems with my heart and fainting im 33 years old and I've had these issues as long as i could remember no one can figure it out i wish i knew wbat was wrong with me im on a journey to find out for myself this was so helpful
I have been dizzy and heart beat irregular after a bacj surgery went wrong ( I suffered MINS with elevated Troponin)..Have CT angiography done with no significant findings)...Now trying to figure out myself what is wrong with me...Thank you for a very interesting lecture...
Great lecture. I have noticed in my practice that EKG is a great help if you pay attention to the hints . Most of the cardiologist ignore EKG considering it a poor diagnostic tools.
This happened to me two sunday's ago. I was standing near my tv with my head turned to the right adjusting the antenna and the very next thing I was aware of was hitting the floor. There was no dizziness, no closing of vision. One instant I was there, the next coming two from hitting the floor. I'm sure I was out for less than a second. I wasn't aware of having been unconscious at all. Felt absolutely fine after, no damage, but terrified and confused. I've had carotid surgery to clear blockages 4 years ago and my PCP suggested this might be "neck tie syncope." I will get Doppler scans of my carotids next week. My concern is that I live alone and I still drive. I am being very cautious not to turn my head to the right or left too far, and only momentarily. I have autonomic nervous system problems that are related to this apparently. (POTS)
I had 5 collapsed, the last year I stayed unconscious for 11 hours, this past Monday I collapsed and my blood pressure felt to 49/26. I don't remembered anything, almost go into cardiac arrest and they are refusing to perform an angiogram on me. Am scared this time, I felt drained, tired, fatige.
Is pulmonary hypertension related to the heart and dizziness? After having a black out this AM I still have tachycardia and and lots of burps. Should I have ECG?
Sir, my father is going through Syncope. He loses his sense instantly and fall flat in ground. Same happens even when his is sitting. He was admitted to a Heart Special Hospital and the Cardiologist Doctors told there is no problem in Heart. Can you Please Please Please Guide me how can we take care of my father in Home now.
good one, i also like how this dr explains things. got a question though. what should we check for if its an HCM in a kid? ive seen a bunch of kids with deep narrow Q in inferior AND lateral leads (well okay, just V5 and V6), and ofc i cant use the voltage criteria in kids at all. so how do i do this? i mean sure q in lead I and avL is a really bad sign no matter the age, but what if it doesnt show?
October 11, 2023 this sounds like my 27 year old son right now! HELP me without scaring the crap outta him! He is on almost every platform FB, Tiktok, ect his name is Urían! If I show him this, he'll go into a panic attack fight or flight that he also suffers with, along with SVT, Cushing's, and many other health conditions. He has many invisible illnesses, he looks athletic 🏃🏻♂️ but is physically sick. He is married with 3 kid's. No health insurance. He can't leave his kid's behind at 27 year's old. Most people downgrade or downplay his symptoms. I know he's sick! I believe him. He had surgery on his pituitary in his brain about 3 years ago for having Cushing's!
Really you are genius ...I love your lectures .But let me ask you a question : does SCN5 genotype study effective and necessary in the diagnosis of Brugada ?
ACID REFLUX INDUCED SYNCOPE. If you have bad acid reflux for many weeks or months the lower gullet sphincter seems to stop working so food backs up in the gullet and feels like you cannot swallow or are choking. Then the pressure of the food causes pressure on the blood vessels from the hart and that reduces blood flow to the brain which suddenly shuts down. It is quite terrifying when it occured to me three times in ten days.
As a paramedic with HCMO, I appreciate this lecture and will use it to teach my employees on what to look for and what not to dismiss. Thank you.
If this guy loves diagnosing syncope so much I wish I could get him to examine my health issues cause I still have no Diagnosis after 6 years.
As a paramedic and flight nurse, I make a note on everything Amal says!!
Damn bro thats cool thank you for your service!!!!11
John K Thank you bud. No need for thanks but it’s nice to hear! I’m humbled.
Thank you for all you do Louis ❤️
Great lecture --very clear and helpful thank you. from a GP in the UK.
I hv been roaming UA-cam for around 20yrs or little less wasting time mostly until just I landed into this M$ lecture, big thank
THANKS!!!
Summary: With syncope patient and ECG evaluation
Look for the "common stuff"
- 1) Ischemia
- 2) Dysarytmias
and the the rare stuff (that you need to look for consciously)
- No 1: HOCM - High voltage + deep-narrow (non ischemic) q-waves (especially lateral leads: I, aVL, V5, V6)
- No 2: Brugada - V1-V2 look for downsloaping ST-elevations (Coved type) > Saddle type . Look in V1+V2 (forget V3; forget about subtypes of brugada - neither are helpfull)
- No 3: WPW - if "normal ECG": look for short PR interval and delta-waves in ALL leads (might be missing in some); if takykardia: "snow flake" (every QRS looks a little different), HR around 300, wide QRS. Don't use AV-nodal blockers
- No 4: Prolonged QTc >500 msek
A note about the computer always correctly interpreting the QT. I had a patient that it interpreted as having approximately 540ms QT and when I looked at the ekg I knew that couldn't be correct, it was around 320ms. The t waves were very flat. I measured from the qrs to the next p wave and got around 540ms. The computer missed the t wave because it was so flat and counted the next p wave as the T. So they're not 100%.
I got extremely dizzy, lied down, and had a 4.5 min seizure-like episode. I was conscious for the episode (although maybe not the entire 4.5m) and with the exception of dizziness, made a complete recovery in less than 1 min. I couldn't move, couldn't yell, could barely whisper, couldn't swallow, had stridor. Your talk was sufficient for me to confirm in my own ECG that I lacked the often overlooked conditions of HCM, Brugada, Arterial fibrillation with WPW, and Long QT brain Hyperperfusion. Knowing what to look for and what is most often missed is of great comfort to this patient.
For those of us following along at home who are not doctors, (I know this is not your audience) it would be helpful if you painted the part of the trace you were referring to in red at the same time as the condition is revealed. I also assume some could benefit from labeling the waveform with QRST.
Meee too😮
I am extremely worried about an episode i had yesterday,i would definitely need some help or advice but the informations i can provide are very fragmatery but i will give it a try.First i have to say i deal with severe stress and the possibility having Brugada syndrome dispite having multiple heart tests and no family history which has lead to sleep to me.Anyway i was in bed tired at 4:30 plus in the morning and was on my phone specifically on UA-cam.Now we jump at 10 in the morning when i woke up and immediately upon i did i had the perception that at some point earlier in the night i found myself under the blanket touching my heart and feeling 2 fast heart beats although it could be my idea(Don't recall shortness of breathing, chest pain or Dizziness but i don't know about confusion or palpitations plus i stayed laying in bed rather having an intense reaction).The other 2 things i remember very clearly were me being on my phone in my right side and under the blanket at(5:40) tired and the other thing was my sister coming into my room taking something and closing the light while only my head was out of the blanket (I don't know which of the 2 events occurred first). Finally at some point it seems like my mother came in and took my phone and said i was snoring.
I want to add upon waking up at 10:00 o'clock and having the perception of that event one side of my mind was saying that it was something serious while another side said it wasn't and the very next thing was a headache from stress plus the more i try now to remember the less i can and the event feels even more disoriented although it could have occurred while i was in my phone because anyway i was very tired the whole time.I am very sorry i can provide very fragmatery informations but could have been recovery from arrithmogenetic syncope in rest ?
I am a Pt. Female 41 . I was diagnosed with vasovagal Syncope this morning. It all started on Nov. 24th in the kitchen. I suddenly got very light headed and freezing cold. I had to lay down. I felt horrible the entire day and couldn't get warm. Several more episodes occurred until the worst one while I was driving on Dec. 2nd when i almost crashed into oncoming traffic. I went to ER and had elevated d dimer and abnormal T wave. I was admitted and had Bradycardia with a high of 51 and low of 37 with a BP of 102/67.
I have "athletes heart" even though I'm not an athlete. Otherwise normal heart with slight bit of atrial regurgitation.
Anyway. I'm still S B with average of 51 bpm.
The Cardiologist is telling me to wear compression hose and to lie down right away if feeling an episode. Or to pull over when driving. I feel like I'm going to end up hurting myself or someone else if I keep driving. But he says to live my life. I don't feel better immediately after these things happen to me. I have super slow pounding in my chest after and I feel confused and dazed for hours after. Should I trust his opinion or seek another opinion?
I feel terrible after as well.Wet with sweat. Weak. Hot and disoriented
I would seek an EP specialist if your cardiologist is not... no offense to them
Same
Amal Mattu is quite simply the best! Especially from an EM point of view.
This is gold. Solid review, and excellent take-home points. At least one class of ACPs will have these on the road. Thanks again. PS - I'm a huge fan of yours and so very thankful that you take the time to educate. Cheers
I'm old and living with heart racing & fainting , been put through the mill for months, still zero help. I am now dizzy 80% of the time. Have all kinds of tests including 2 weeks heart monitor. No diagnosis. Not fun.
Meee too😮😮
I'm so sorry to hear this
Great review for me, it's amazing how important spaced repetition is, thank you.
I have nuerocardiogenic syncope. My electrocardiologist has been wanting me to get a pacemaker for the last year. I've been avoiding it because I'm only 40. Now I'm considering it.
So glad I watched this. I will take this knowledge back to the streets when dealing with syncope patients.
My dad has obstructive HC and last week had syncope for the first time. He refused to go to the doctor or hospital at the time. This video helped me anyway as a lay person.
Dad died 3 weeks ago 😔. Thank you for teaching us about this. It still helps.
Thank you for this video. I have recently been experiencing syncope & this was super helpful!!
I have problems with my heart and fainting im 33 years old and I've had these issues as long as i could remember no one can figure it out i wish i knew wbat was wrong with me im on a journey to find out for myself this was so helpful
Did you ever find out? I have had EKG's and test galore, yet no one can tell me why this is happening.
I have been dizzy and heart beat irregular after a bacj surgery went wrong ( I suffered MINS with elevated Troponin)..Have CT angiography done with no significant findings)...Now trying to figure out myself what is wrong with me...Thank you for a very interesting lecture...
Thanks!just yesterday we lost a young girl from first time seizures.your pathophysiology is awesome!Nkqubela (south africa)
damn the amount of practical knowledge is insane
Great lecture. Fan of you Dr.Mattu.Keep sharing, n educating.
Tthank you a lot.
Great lecture. I have noticed in my practice that EKG is a great help if you pay attention to the hints .
Most of the cardiologist ignore EKG considering it a poor diagnostic tools.
GREAT TEACHER AND COMMUNICATOR !!
This happened to me two sunday's ago. I was standing near my tv with my head turned to the right adjusting the antenna and the very next thing I was aware of was hitting the floor. There was no dizziness, no closing of vision. One instant I was there, the next coming two from hitting the floor. I'm sure I was out for less than a second. I wasn't aware of having been unconscious at all. Felt absolutely fine after, no damage, but terrified and confused. I've had carotid surgery to clear blockages 4 years ago and my PCP suggested this might be "neck tie syncope." I will get Doppler scans of my carotids next week. My concern is that I live alone and I still drive. I am being very cautious not to turn my head to the right or left too far, and only momentarily. I have autonomic nervous system problems that are related to this apparently. (POTS)
Wow!!! Amazing lecture!!! Thank you!!!!
11:30 syncope is on the spectrum of death
I teach EKG and this man is AMAZING!!
Thanks for sharing this amazing lecture , I hope I will find all lectures by dr amal mattu♥️🙏🏻
Amal is the master!
Professor, you're a genius and my idol
Excellent Talk. Very informative and Educational.
Nobody makes electeocardiology as fun as Amal
Excellent talk Amal and very informative
Ì try to absorb any words as pure gold ....
Marvelous review & insights again. thank you!
differential should include pulmonary embolism. sometimes syncope is the only clue. there might not be typical ECG changes.
Totally awsome lecture 🤗
Excellent. I loved it.
Amazing lecture. I'm excited!
I had 5 collapsed, the last year I stayed unconscious for 11 hours, this past Monday I collapsed and my blood pressure felt to 49/26. I don't remembered anything, almost go into cardiac arrest and they are refusing to perform an angiogram on me. Am scared this time, I felt drained, tired, fatige.
How are your feeling today dear?
great lecture!
Excellent presentation. Very well explained.
The bar called Brugada must to be warning if one eats there then they must to test for Brugada.
Love your videos!
Teacher of par excellence 🤗
Could you make a video about brain zaps following by fainting?
I have a non - specific gene for sudden cardiac death...it's really scary to me.😮
It’s said whoever saves one life it’s like they saved all life thanks you to all the real heroes you are appreciated.
Awesome sir
Dr Mattu makes the call using his AI (brain) and the ECG machines can't pattern-recognize Brugada as a DDx, very curious?
So a syncope will show up on an ecg? Does that have to be recently after or will it show after in the same way they can tell you've had an attack?
Is pulmonary hypertension related to the heart and dizziness?
After having a black out this AM I still have tachycardia and and lots of burps. Should I have ECG?
IM A CARDIOGENIC SYNCOPE PERSON WHEN BLACKING OUT I DO WONDER IF IM GOING TO RETURN THAT I HAVE BEEN HAVING FOR SO LONG OVER 13 IN MY 60TY YEARS SCARY
Sir, my father is going through Syncope. He loses his sense instantly and fall flat in ground. Same happens even when his is sitting. He was admitted to a Heart Special Hospital and the Cardiologist Doctors told there is no problem in Heart. Can you Please Please Please Guide me how can we take care of my father in Home now.
great lecture
good one, i also like how this dr explains things. got a question though. what should we check for if its an HCM in a kid? ive seen a bunch of kids with deep narrow Q in inferior AND lateral leads (well okay, just V5 and V6), and ofc i cant use the voltage criteria in kids at all. so how do i do this? i mean sure q in lead I and avL is a really bad sign no matter the age, but what if it doesnt show?
32:00 round up inc long QT
October 11, 2023 this sounds like my 27 year old son right now! HELP me without scaring the crap outta him! He is on almost every platform FB, Tiktok, ect his name is Urían! If I show him this, he'll go into a panic attack fight or flight that he also suffers with, along with SVT, Cushing's, and many other health conditions. He has many invisible illnesses, he looks athletic 🏃🏻♂️ but is physically sick. He is married with 3 kid's. No health insurance. He can't leave his kid's behind at 27 year's old. Most people downgrade or downplay his symptoms.
I know he's sick! I believe him.
He had surgery on his pituitary in his brain about 3 years ago for having Cushing's!
thanks from gp in uran
can 4 abnormal t waves on an ecg combined with fainting, migraine and vomiting be cardiac syncope or is it nothing to look into
Very nice
Thankyou
What would they think it is the spikes like that
Niice work
Really you are genius ...I love your lectures .But let me ask you a question : does SCN5 genotype study effective and necessary in the diagnosis of Brugada ?
What is the date for course release?
We’re planning on having the course online in the next 2 months. We will announce when it’s for sale. Thanks!
That O J reference though 😎
Japan is not tropical but Brugada is more common in Japanese men.
Wow!!!! Thanks
Great lecture. I never thought of looking for HCM.
ACID REFLUX INDUCED SYNCOPE.
If you have bad acid reflux for many weeks or months the lower gullet sphincter seems to stop working so food backs up in the gullet and feels like you cannot swallow or are choking.
Then the pressure of the food causes pressure on the blood vessels from the hart and that reduces blood flow to the brain which suddenly shuts down.
It is quite terrifying when it occured to me three times in ten days.
35:20 etoh chronic all have prolngd qt
great...
2:00 2 no brainers, 2 intervalopathies, 2 genetics
Now I will take syncope very seriously!!!Nkqubela
There are stories of Asian women dressing their sons as girls for bedtime because Brugada was so much more common in boys 😢
bril as always
Smooth anointed, what? Muscle! isn't a jagged-- electronic dynamic signal! N= not ever!
🙏🙏🙏🙏🙏
20:00 brugada
Beauty
F
hahaha so jack daniels ia a diagnosis now