• 15-25% of children experience at least one syncopal episode by young adulthood
  • Heart Disease has been the attributed etiology in as high as 10-28% of these cases
    • Historical features suggestive of Cardiac etiology (similar to adults):
      • Onset with exertion
      • No prodome or premonitory symptoms; Resulted in bodily injury
      • Incontinence, Seizure-like activity (VTach often looks like a seizure – in my experience anyway)
      • Abnormal Cardiac Structure or previous cardiac surgery
      • Family Hx of unexplained Death or Accidents (MVC)
      • Required CPR
      • Resulted in neurological insult

Get the EKG! Look for…

  1. WPW
  2. Prolonged QTc (QTc > 460ms)
  3. Shortened QTc – (QTc < 320ms)
  4. AV blocks
  5. BRUGADA Syndrome – Yes, even in kids!

Work Up

  • If the patient is at baseline, there is little need for extensive work-up.
  • ECG, low yield, but good screen for most life-threatening cardiac etiologies
  • Consider glucose level and hemoglobin (particularly post-menarche girls)
  • Urine pregnancy test (TRUST NO ONE!!- ok, maybe you don’t have to check it on the boys)
  • Good physical exam with particular focus on neuro portion.

Johnsrude, C.L., Current approach to pediatric syncope. Pediatr Cardiol, 2000. 21(6): p. 522-31.

Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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