Pediatric Syncope

Aka: Pediatric Syncope, Syncope in Children

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II. Epidemiology

  1. Pediatric Syncope is common and most cases are of benign cause
    1. Syncope occurs in 10% of children under age 10 years old

III. History

  1. Reassuring findings
    1. Recent illnesses predisposing to Dehydration
    2. Frequent episodes
  2. Concerning findings
    1. Syncope with Exertion
      1. See Exertional Syncope
    2. Syncope with symptoms that occur when at complete rest

IV. Causes

  1. See Syncope
  2. Benign causes (most children)
    1. Orthostatic Hypotension
    2. Reflex Mediated Syncope (no Cardiovascular Risk)
      1. Vasovagal Syncope (Vasodepressor Syncope)
      2. Micturition Syncope or with Defecation
      3. Valsalva (brass instrument playing, weight lifting)
      4. Hyperventilation
  3. Serious causes (risk of sudden death)
    1. Arrhythmia causes
      1. Wolff-Parkinson-White Syndrome (WPW Syndrome)
      2. Brugada Syndrome
      3. Prolonged QTc >500 ms
      4. Arrhythmogenic Right Ventricular Dysplasia (ARVD)
      5. Huffer's Ventricular Tachycardia (Huffing or Inhalant Abuse)
    2. Structural causes
      1. Aortic Stenosis
      2. Hypertrophic Cardiomyopathy
      3. Prior cardiac surgery (esp. ventricle)
    3. Other causes
      1. Sudden unexplained death in Epilepsy (SUDEP)
      2. Commotio Cordis
      3. Pulmonary Embolism
      4. Pulmonary Hypertension (typically in Congenital Heart Disease)

V. Diagnostics

  1. Electrocardiogram
    1. See Electrocardiogram in Syncope
  2. Echocardiogram
  3. Event Monitor or Holter Monitor

VI. References

  1. Orma and Sloas in Herbert (2016) EM:Raap 16(7):3-4

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