Etiology and prognosis of children and adolescents with situational syncope

Abstract

Objective To retrospectively analyze the etiology and prognosis of the children and adolescents with situational syncope in a single center. Methods There were 4 274 cases of children and adolescents [aged from 2 to 18 years old, the average age being (10.82 ± 3.13) years old], male 2 208 cases, female 2 066 cases with orthostatic intolerance syndromes, such as unexplained syncope or symptoms of presyncope, etc, who were treated at Children′s Syncope Outpatient Department or Inpatient Department in the Second Xiangya Hospital, Central South University from January 2000 to November 2017.All subjects underwent detailed history investigation, careful physical examinations, routine 12-lead electrocardiogram, Holter electrocardiogram(ECG), chest X-ray, echocardiography, electroencephalogram(EEG) and head computerized tomography(CT) or magnetic resonance imaging(MRI), blood biochemical examination (including fasting glucose, myocardial enzymes) and organic diseases in the heart, brain, blood vessels were excluded, but the cause of syncope was still not clear.The head-up tilt table test (HUTT) was performed after the patients or/and the families wrote the informed consent agreement. Results A total of 177 (4.14%) patients with situational syncope were diagnosed among 4 274 cases.Etiology included the abdominal musecle exercise (35.59%, 63/177 cases), urination (24.29%, 43/177 cases), bathing (9.60%, 17/177 cases), defecation (7.34%, 13/177 cases), singing (5.08%, 9/177 cases), rides (4.52%, 8/177 cases), blood-injection-injury phobia (3.95%, 7/177 cases), swallowing (3.39%, 6/177 cases), and hair-grooming (2.82%, 5/177 cases), syncope during acupuncture treatment (2.26%, 4/177 cases), and cough (1.13%, 2/177 cases). The common positions were upright position (84.18%, 149/177 cases), squatting to standing position (8.47%, 15/177 cases), sitting position (5.08%, 9/177 cases), and squatting position (2.26%, 4/177 cases). HUTT positive rate was 69.49% (123/177 cases), common type of hemodynamic were the vasodepressive type of vasovagal syncope (45.20%, 80/177 cases), mixed type of vasovagal syncope (19.77%, 35/177 cases), postural orthostatic tachycardia syndrome (3.39%, 6/177 cases) and the cardiac suppressive type of vasovagal syncope (1.13%, 2/177 cases). In 35 cases of situational syncope, the number of children and adolescents with syncope was significantly reduced by health education and upstanding training.By the first follow-up review, the cases were reduced from (2.69 ±1.81) times to (0.59 ± 0.96) times after healthy education of 2-16 weeks [(4.97±3.16) weeks]. By the second follow-up review, 3 out of 8 cases did not faint, 3 cases fainted 1 time, 1 case fainted 2 times, and 1 case fainted 4 times.The outcomes of the first reexamination of HUTT in 16 cases were negative, and other 3 cases were negative by twice visit. Conclusions The etiology of children and adolescents are flag-raising(abdominal muscle exercise), urination, bathing, defecation, singing, riding, blood-injection-injury phobia, swallowing, hair-grooming, syncope during acupuncture treatment and coughing.Healthy education is good for situational syncope. Key words: Situational syncope; Head-up tilt table test; Etiology; Healthy education; Prognosis; Child; Adolescent