This infographic provides a mnemonic tool called “WOBBLER” for assessing an ECG (electrocardiogram) in cases of syncope (temporary loss of consciousness due to reduced blood flow to the brain). It is designed to help clinicians systematically evaluate potential causes of syncope by focusing on specific abnormalities in the ECG. Here’s a breakdown of the mnemonic: WOBBLER: Each letter corresponds to a specific potential ECG abnormality and the section of the ECG to focus on. • W: Wolff-Parkinson-White Syndrome (WPW) • ECG Section: P, PR intervals • WPW is associated with a short PR interval and a delta wave. It indicates an accessory pathway that can cause arrhythmias. • O: Obstructed AV Pathway • ECG Section: PR interval • This refers to conduction delays or blocks in the atrioventricular (AV) node, such as first-degree AV block (prolonged PR interval). • B: Bifascicular Block • ECG Section: QRS complex • A bifascicular block is a conduction abnormality involving two of the three major fascicles of the heart’s conduction system. It may present as a widened QRS complex. • B: Brugada Syndrome • ECG Section: ST segment • This syndrome is characterized by a coved ST-segment elevation in the right precordial leads (V1-V3) and is associated with a high risk of sudden cardiac death. • L: Left Ventricular Hypertrophy (LVH) • ECG Section: QRS complex (and sometimes QRST combination) • LVH can indicate underlying structural heart disease like aortic stenosis (AS) or hypertrophic obstructive cardiomyopathy (HOCM). • E: Epsilon Wave • ECG Section: ST segment • Epsilon #clinical #diagnosis waves are small positive deflections at the end of the QRS complex, seen in arrhythmogenic right ventricular cardiomyopathy (ARVC). • R: Repolarization Abnormality • ECG Section: QT interval • This includes long QT syndrome or short QT syndrome, both of which predispose individuals to life-threatening arrhythmias. Purpose: The mnemonic is intended for patients who do not have obvious ischemia or dysrhythmia on their ECG and are well-appearing despite their syncope. It helps in detecting subtle yet potentially life-threatening ECG findings that may explain the syncope. Clinical Utility: • Syncope evaluation: Guides the physician to focus on potentially dangerous yet subtle ECG abnormalities. • Risk stratification: Identifies patients at risk for sudden cardiac death or serious arrhythmias. • Efficiency: Provides a systematic approach to quickly screen ECGs without missing critical findings. This tool is especially helpful in emergency and primary care settings for efficient, thorough ECG interpretation. #cardiology #differential #echocardiogram #syncope #emergency