2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

Comments on 2018 CPCS guideline for diagnosis and treatment of syncope in children and adolescents

“…However, its pathogenesis, etiologies, diagnosis and management are complex.The studies on syncope attract great interest of pediatricians and great progress has been made in this interesting field. Based on the improvement achieved so far, Chinese Pediatric Cardiology Society (CPCS) successfully developed a guideline for the diagnosis and treatment of syncope in children and adolescents, which would greatly improve the level of clinical management of syncope [3].…”

“…In this guideline, a clear and standard diagnostic flowchart is included, which makes the diagnosis efficient and economical, and the efficacy of diagnosis would be improved profoundly [4,5]. In the guideline, the flowchart is divided into 2 steps [3]. The first step includes history-taking, physical examination and supine and upright heart rate, blood pressure as well as electrocardiography.…”

“…Health education is always the first-line therapy for syncopal patients, which is emphasized in the guideline [3]. Recognizing the common triggers and avoiding them, identifying presyncopal symptoms and performing self-saving maneuvers like changing positions or counter-pressure maneuver, ensuring appropriate physical exercise, as well as maintaining psychological health are the primary strategies to cope with syncope [11].…”

“…Notably, guardians should be atten-dant for its possibility of inducing syncope or presyncope. In the guideline, another nonpharmacological method is recommended to increase the intake of water and salt based on the mechanism of hypovolemia [3]. Increasing studies have testified its efficacy, but patients with hypertension, kidney disease or heart failure are not within the scope [14].…”

“…Based on multiple mechanisms participating in the pathogenesis of syncope, a few kinds of pharmacological therapies have been suggested when patients have poor response to non-drug therapy, presyncope with risk of injury or recurrent syncope [1]. Nonetheless, this guideline recommends the utility of midodrine hydrochloride and metoprolol individually [3]. In 2006, a relatively small-scale study conducted by Du's team firstly showed that midodrine hydrochloride was effective for pediatric vasovagal syncope [15], which supplied pediatricians a new choice of treatment and this study received positive evaluation from Stewart [16].…”