Syncope (peds)

For adult patients see syncope

Background

  • Usually because of an abrupt cerebral hypo-perfusion (30-50% from baseline)
  • Peak age: 15-19 years of age
  • In younger children, usually due to seizures, breath holding or cardiac disease

Red flags

  • Exercise-induced collapse
  • Chest pain
  • Previous cardiac surgery
  • Family history of:
    • Sudden Death
    • Cardiac disease at early age
    • Unexplained deaths
    • Death due to single-vehicle accident
    • Drowning
    • SIDS

Clinical Features

  • Abrupt loss of consciousness with full recovery after a short duration

Differential Diagnosis

Evaluation

  • ECG – looking for:
    • 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
  • Capillary blood sugar
  • Tox screen (urine or serum – based on clinical scenario)
  • Beta-HCG
  • Serum extended electrolytes, CBC, TSH
  • Bedside cardiac ultrasound
    • Cardiac hypertrophy or pericardial effusion
    • Assess the IVC for dehydration

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.
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