SummaryIn the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even though most causes of syncope in childhood are benign, and life-threatening causes of syncope generally have cardiac etiology. In all these cases, routine evaluation includes history, physical examination and a 12-lead standard electrocardiogram which should be performed. Further investigation is indicated by worrying features which include syncope that occurs without warning, syncope during exercise, history of familial sudden death, and abnormalities on clinical exam or electrocardiography. The fact is that syncope generates great fear of injury or sudden death among parents and doctors, and the main aim of the present paper is to help the physician involved in the care of children to differentiate the life-threatening causes of syncope from the common, more benign neutrally-mediated syncope.
References
1.
Tretter JT, Kavey REW. Distinguishing Cardiac Syncope from Vasovagal Syncope in a Referral Population. The Journal of Pediatrics. 2013;163(6):1618-1623.e1.
2.
WOLFF GS. Unexplained Syncope: Clinical Management. Pacing and Clinical Electrophysiology. 1997;20(8):2043–7.
3.
Calkins H, Seifert M, Morady F. Clinical presentation and long-term follow-up of athletes with exercise-induced vasodepressor syncope. American Heart Journal. 1995;129(6):1159–64.
4.
Huff JS, Decker WW, Quinn JV, Perron AD, Napoli AM, Peeters S, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Syncope. Annals of Emergency Medicine. 2007;49(4):431–44.
5.
PRATT JL, FLEISHER GR. Syncope in children and adolescents. Pediatric Emergency Care. 1989;5(2):80–2.
6.
Lewis DA, Zlotocha J, Henke L, Dhala A. Specificity of Head-Up Tilt Testing in Adolescents: Effect of Various Degrees of Tilt Challenge in Normal Control Subjects. Journal of the American College of Cardiology. 1997;30(4):1057–60.
7.
Gibson TC, Heitzman MR. Diagnostic efficacy of 24-hour electrocardiographic monitoring for syncope. The American Journal of Cardiology. 1984;53(8):1013–7.
8.
Driscoll DJ, Jacobsen SJ, Porter C burn J, Wollan PC. Syncope in Children and Adolescents. Journal of the American College of Cardiology. 1997;29(5):1039–45.
9.
Villain E. Syncopes d’origine cardiaque chez l’enfant. Archives de Pédiatrie. 2004;11(2):169–74.
10.
Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). European Heart Journal. 2009;30(21):2631–71.
11.
Johnsrude CL. Current Approach to Pediatric Syncope. Pediatric Cardiology. 2000;21(6):522–31.
12.
Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Syncope in pediatric patients presenting to an emergency department. The Journal of Pediatrics. 2004;145(2):223–8.
13.
Walsh K, Hoffmayer K, Hamdan MH. Syncope: Diagnosis and Management. Current Problems in Cardiology. 2015;40(2):51–86.
14.
Côté JM. Syncope in children and adolescents: Evaluation and treatment. Paediatrics & Child Health. 2001;6(8):549–51.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
