21 year old woman with CP, SOB, then syncope, and with ST depression with T-wave inversion in V1-V3

In this study, except for troponin elevation,Gestalt was the best predictor.The article does not specify the QT correction methodWhy is right ventricular hypertrophy (RVH) not found in this large study of syncope?  Probably because it is not common enough to be identified in a general syncope study.  Not every high risk factor will be identified in such studies, but it is obvious that RVH is a dangerous condition and that, if identified on ECG, needs further workup.  Why were so few ECG findings predictive?Because most abnormal ECG findings were considered adverse outcomes in their own right and not evaluated as predictors!!Why does pulmonary hypertension cause syncope?The RV normally functions at low pressure, MAP about 15, or 20/12.  Unlike the LV, which is under high pressure during systole, and therefore is perfused during diastole, the RV can be perfused during the entire cardiac cycle.  Her resting pulmonary pressure is 80/26, and so her RV can only perfuse during diastole. In addition, the RV is usually thin-walled with high compliance, and is able to expand the free wall when there is increased preload.With a stiff RV, any sudden increase in RV pressure leads to both RV ischemia (and resulting RV dysfunction, with some degree of pump failure), decreased RV output, and thus decreased LV filling (lowered diastolic filling pressure due to poor RV output, and decreased LV size due to septal bulging).  All of this means decreased LV ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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