Management of syncope in pediatric patients

Abstract

Syncope is a common symptom in children, particularly in the teenage years. Although most often benign, it can be a symptom of serious underlying conditions and may result in sudden death. It is estimated that approximately 1% to 2% of children presenting with syncope have a serious underlying disorder. Therefore, it is important to assess patients logically and be able to separate those with serious pathology from those without. A good history is the most important step in this regard, and can save a significant amount of anxiety, time, and money for the patient and for the health care system. Most patients can be determined to have vasovagal syncope on the basis of a good history, physical examination, and standard electrocardiogram. Other tests, such as echocardiography and electrocardiogram monitoring (eg, Holter/event monitors, including implantable event monitors), may be reserved for those with abnormalities in the initial workup. Therapy depends on the underlying disorder. Vasovagal syncope may only need reassurance and volume loading with increase in salt and water intake.

Vasovagal syncope misdiagnosed as epilepsy for 17 years: prime importance of clinical history

“…Neurocardiogenic (vasodepressor or neurally-mediated syncope) is the most common type and is considered to be benign (McLeod 2002). Nonetheless, in 1% to 2% of children presenting with syncope, a serious underlying disorder may be present, such as aortic stenosis, hypertrophic cardiomyopathy or coronary malformations that necessitates prompt diagnosis (Batra and Balaji 2005). Ictal bradycardia and asystole have been reported in seizures that originate in the temporal lobes, and most often occurs in association with bilateral hemispheric seizure activity (Britton et al 2006).…”

“…Neurocardiogenic (vasodepressor or neurally‐mediated syncope) is the most common type and is considered to be benign (McLeod 2002). Nonetheless, in 1% to 2% of children presenting with syncope, a serious underlying disorder may be present, such as aortic stenosis, hypertrophic cardiomyopathy or coronary malformations that necessitates prompt diagnosis (Batra and Balaji 2005).…”