Elsevier

Cardiology Clinics

Volume 15, Issue 2, 1 May 1997, Pages 277-294
Cardiology Clinics

SYNCOPE IN THE PEDIATRIC PATIENT

https://doi.org/10.1016/S0733-8651(05)70336-2Get rights and content

Syncope during childhood is common. A variable incidence has been reported, from 1 of 2000 emergency department visits,71 to 47% of interviewed college students.61 Driscoll and colleagues14 reported an overall incidence of 125 of 100,000 (0.125%) for pediatric patients seeking medical attention. Girls were seen for evaluation more commonly than boys, with the peak incidence occurring between ages 15 and 19 years. Despite its frequency, syncope generates an extraordinary amount of anxiety among patients, families, teachers, coaches, and physicians.

In children and adolescents, the list of causes is generally similar to that described for adults, although the relative frequency and prognosis for the individual diagnoses are somewhat unique. Fortunately, most syncopal events in young patients are isolated and benign in nature. Driscoll's data14 revealed an association of sudden death and prior syncopal events that was not different from that of sudden death in the general population. This article describes the causes, diagnosis, and treatment of syncope in infants, children, and adolescents, focusing on the differences that must be identified when caring for the pediatric versus adult patient. Recommendations are presented for an economically efficient diagnostic workup and practical approach to treatment.

Section snippets

CAUSE

Syncope can be classified into three categories: cardiac, noncardiac, and neurocardiogenic (or vasovagal) (Table 1). For young patients, neurocardiogenic events clearly account for the majority of episodes, but the goal of all evaluations must be the accurate identification of the rare individual with potentially serious pathology.

DIAGNOSTIC EVALUATION

Pediatric syncope is a common clinical problem that requires a thorough diagnostic investigation to ensure the detection of potentially life-threatening diagnoses and the provision of accurate prognostic information. A thorough history is frequently the most important part of the evaluation. The pediatric patient may often not be able to provide a complete or specific history. In those cases, however, parents, relatives, and teachers can frequently contribute important clues to the cause of the

CONCLUSION

Syncope is a common pediatric problem and usually has a benign, neurally mediated cause. The clinician must be aware, however, of the occasional life-threatening causes for syncope in children and adolescents, which can usually be suspected and detected simply on the basis of history, physical examination, and ECG.

ACKNOWLEDGMENT

We thank Emily Flynn McIntosh for assistance with the figures and Christine Dindy for locating representative electrocardiographic traces for illustrative purposes.

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    Address reprint requests to Ronn E. Tanel, MD, Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115

    RET is currently supported by a research fellowship from the American Heart Association, Massachusetts Affiliate, Inc.

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    Copyright © 1997 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.