We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Pediatric syncope
From WikEM
Contents
Background
- Usually because of an abrupt cerebral hypo-perfusion (30-50% from baseline)
- Peak age: 15-19 years of age
- In the 6 year old – usually due to seizures, breath holding or cardiac issue.
Red flags
- Exercise-induced collapse
- Chest pain
- Previous cardiac surgery
- Family history of:
- Sudden Death
- Cardiac disease at early age? or Pacemaker?
- Drowning
- SIDS
Clinical Features
- Abrupt loss of consciousness with full recovery after a short duration
Differential Diagnosis
- Toxicological (stimulants or depressant)
- CO poisoning
- Breath-holding spell
- Tet spell
Evaluation
- ECG – looking for:
- WPW – short PR, Delta waves, wide QRS
- Long QT syndrome – QTc >0.450 sec
- Hypertrophic Cardiomyopathy – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves
- Bruagada syndrome – refer to Brugada (incomplete RBBB with ST elevations in V1-3)
- Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3. Epsilon wave is pathognemonic (up-notching of a terminal Q wave)
- Tox screen (urine or serum – based on clinical scenario)
- Beta-HCG
- Serum extended electrolytes, CBC, TSH
- Bedside cardiac ultrasound
- Cardiac hypertrophy or pericardial effusion
- Assess the IVC for dehydration
Management
- Directed towards reversing the cause
Disposition
- Admission if any ECG abnormality found
- Admission usually not warranted – consider admitting kids with eating disorder
See Also
References
- Fischer and Cho. Pediatric Syncope: cases from the ED. Emerg Med clin N Am. Vol 28. 2010. Pp 501-516.
