Syncope
Syncope
- 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
- Historical features suggestive of Cardiac etiology (similar to adults):
Get the EKG! Look for…
- WPW
- Prolonged QTc (QTc > 460ms)
- Shortened QTc – (QTc < 320ms)
- AV blocks
- 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.
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