Syncope (peds): Difference between revisions
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''For adult patients see [[syncope]]'' | ''For adult patients see [[syncope]]'' | ||
==Background== | ==Background== | ||
*Usually because of an abrupt cerebral | *Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline) | ||
*Peak age: 15-19 years of age | *Peak age: 15-19 years of age | ||
*In younger children, usually due to seizures, breath holding or cardiac disease | *In younger children, usually due to [[seizure (peds)|seizures]], [[breath-holding spell]] or cardiac disease | ||
===Red flags=== | ===Red flags=== | ||
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**Unexplained deaths | **Unexplained deaths | ||
**Death due to single-vehicle accident | **Death due to single-vehicle accident | ||
**Drowning | **[[Drowning]] | ||
**[[SIDS]] | **[[SIDS]] | ||
| Line 21: | Line 21: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX syncope peds}} | |||
==Evaluation== | ==Evaluation== | ||
*[[ECG]] – | ===Workup=== | ||
**WPW – short PR, Delta waves, wide QRS | *[[ECG]] | ||
**Long QT syndrome – QTc >0.450 sec | *Urine pregnancy (if age/sex appropriate) | ||
**Hypertrophic | |||
**Brugada syndrome – incomplete RBBB with ST elevations in V1-3 | |||
**Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave) | ;Consider based on history/symptoms: | ||
** Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG | *CBC (or POC hemoglobin) & chemistry (or POC glucose) | ||
*TSH | |||
*[[Tox screen]] (urine or serum – based on clinical scenario) | |||
*Bedside cardiac [[echocardiography]] | |||
**Cardiac hypertrophy or [[pericardial effusion]] | |||
**Assess the IVC for [[dehydration]] | |||
===Diagnosis=== | |||
*ECG may show: | |||
**[[WPW]] – short PR, Delta waves, wide QRS | |||
**[[Long QT syndrome]] – QTc >0.450 sec | |||
**[[Hypertrophic cardiomyopathy]] – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves | |||
**[[Brugada syndrome]] – incomplete RBBB with ST elevations in V1-3 | |||
**[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave) | |||
**[[Catecholaminergic polymorphic ventricular tachycardia]] - May present with VT/VF due to emotional stress or a regular ECG | |||
==Management== | ==Management== | ||
Latest revision as of 12:24, 14 May 2022
For adult patients see syncope
Background
- Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)
- Peak age: 15-19 years of age
- In younger children, usually due to seizures, breath-holding spell or cardiac disease
Red flags
- Exercise-induced collapse
- Chest pain
- Previous cardiac surgery
- Family history of:
Clinical Features
- Abrupt loss of consciousness with full recovery after a short duration
Differential Diagnosis
Syncope (peds)
- Seizure
- Breath-holding spell
- Hyperventilation syndrome
- Pregnancy (especially ectopic)
- Hypoglycemia
- Cardiac disease
- Toxicologic exposure (stimulants or depressant)
Evaluation
Workup
- ECG
- Urine pregnancy (if age/sex appropriate)
- Consider based on history/symptoms
- CBC (or POC hemoglobin) & chemistry (or POC glucose)
- TSH
- Tox screen (urine or serum – based on clinical scenario)
- Bedside cardiac echocardiography
- Cardiac hypertrophy or pericardial effusion
- Assess the IVC for dehydration
Diagnosis
- ECG may show:
- WPW – short PR, Delta waves, wide QRS
- Long QT syndrome – QTc >0.450 sec
- Hypertrophic cardiomyopathy – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves
- Brugada syndrome – incomplete RBBB with ST elevations in V1-3
- Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)
- Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG
Management
- Directed towards reversing the cause
Disposition
- Admission if any ECG abnormality found
- Admission usually not warranted – consider admitting kids with eating disorder
- Consider discharge home with cardiology consult and strict activity restrictions if suspicion of hypertrophic cardiomyopathy in otherwise well patient with reliable caretakers
See Also
References
- Fischer and Cho. Pediatric Syncope: cases from the ED. Emerg Med clin N Am. Vol 28. 2010. Pp 501-516.