Syncope In Pediatric Patients Research Articles

The association between patent foramen ovale and unexplained syncope in pediatric patients

BackgroundPatent foramen ovale (PFO) is associated with transient ischemia attack (TIA) or stroke, paradoxical embolism, and migraines. PFO closure decreases the recurrent incidence of cerebral ischemic events and reduces the incidence of syncope in adults. However, whether PFO is associated with syncope in pediatric patients has not been investigated.Methods1001 pediatric patients (aged 4 to 17 years, mean age 10.31 ± 2.61 years, 519 males) who complained of unexplained syncope, palpitation, headache, dizziness and chest pain and were hospitalized in the Syncope Ward, The Second Xiangya Hospital, Central South University between January 2013 and April 2022 were recruited. Children with definite etiology of syncope, neurological, cardiogenic, psychological and other system diseases were excluded. PFO was measured by transthoracic echocardiography and right-heart contrast echocardiography was performed to identify the presence of right-to-left shunting. The demographic data and medical records were retrospectively reviewed and analyzed.Results276 cases were included in the simple syncope group, 379 cases in the headache/dizziness group, 265 cases in the chest pain group, and 81 cases in the palpitation group. The incidence of PFO between the four groups was insignificant (4.71%, 4.74%, 4.15%, 6.17%, respectively, P = 0.903). Multivariate Logistic regression demonstrated that PFO is not associated with the increased risk of syncope (P = 0.081).ConclusionPFO may not increase the risk of syncope in pediatric patients. Further study may include a large and multicenter sample to investigate the association between PFO and unexplained syncope.

The Diagnosis and Management of Vasovagal Syncope in Pediatric Patients

Vasovagal syncope is the most common cause of syncope in pediatric patients. The present study is aim to provide a comprehensive literature review of the latest advances in the diagnosis and treatment of vasovagal syncope in children. Diagnosis of vasovagal syncope is based on clinical history. For patients with suspected VVS but lack of confident diagnosis after initial assessment, head-up tilt test is helpful. There are four options for treatment of vasovagal syncope: conservative therapy, pharmacologic therapy, pacemaker therapy, and catheter ablation of ganglionated plexi. Conservative therapy (health education, avoidance of triggers, salts and water intake, physical countermeasures and orthostatic training) is recommended for patients with occasional syncope. Pharmacological therapy should be considered for patients with recurrent syncope or for whom conservative therapy has failed. Patients with the predominantly cardioinhibitory response, associated with repeated injury, limited prodromes, and documented asystole may benefit from cardiac pacing. Catheter ablation of ganglionated plexi is a new strategy, its efficacy and safety in pediatric patients should be verified by randomized controlled trials.

Diagnosis and treatment of syncope in pediatric patients: a new guideline

Diagnosis and treatment of syncope in pediatric patients: a new guideline

Detailed Histories Identify Cardiac Syncope in Pediatric Patients

Detailed Histories Identify Cardiac Syncope in Pediatric Patients

A 9-Year-Old Boy with Exertional Syncope

BackgroundSyncope in the pediatric population is a common and mostly benign event. There is a subset of patients, however, in whom exertional syncope is the manifestation of a life-threatening cardiac abnormality. ObjectiveWe present a rare but serious cause of syncope in children that often presents as sudden cardiac death. Case ReportA 9-year-old boy presented to the Emergency Department (ED) after an episode of exertional syncope while in physical education class. This was the patient’s second episode of exercise-induced syncope within a 2-year period. There was no family history of sudden death or cardiac disease. The child had not undergone any prior diagnostic work-up for the syncope. He was admitted to the hospital for further evaluation, and was found to have an anomalous left coronary artery on transthoracic echocardiogram. ConclusionAs a potential precursor of sudden death, exertional syncope in pediatric patients should prompt a thorough evaluation for a cardiac etiology.

Cardiac Syncope in Pediatric Patients

To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management. We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope. A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation. Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations.

Management of syncope in pediatric patients

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.

Syncope in pediatric patients presenting to an emergency department

Objective To assess the epidemiology of syncope coming to medical attention among unselected children referred to an emergency department in Western Europe. Study design We analyzed the cause of syncope and diagnostic workup of 226 consecutive pediatric patients seen in our emergency department because of a syncopal event. Results Neurocardiogenic syncope and neurologic disorders were the most common diagnoses (80% and 9%, respectively). Other causes included psychologic, cardiac, respiratory, toxicologic, and metabolic problems. The neurocardiogenic and disease-related syncopes were easily identified or suspected by history and physical examination. Electrocardiography was not performed in 132 cases (58%). Most patients with suspected neurocardiogenic syncope had an electroencephalogram, and 29% were admitted to the hospital. Cardiac disorders represented 5 cases (2%); 2 had been previously misdiagnosed. Conclusions Syncope in children can result from a wide variety of causes. Consequently, an evaluation that fails to approach this problem in a goal-directed fashion proves to be very expensive, time-consuming, and frustrating to all concerned. Thorough history and physical examination are usually all that are necessary to guide practitioners in choosing the diagnostic tests that apply to a given patient.

P-252 Head-up tilt testing potentiatedwith sublingual nitroglycerin for the evaluation of unexplained syncope in pediatric patients

P-252 Head-up tilt testing potentiatedwith sublingual nitroglycerin for the evaluation of unexplained syncope in pediatric patients

P-252 Head-up tilt testing potentiatedwith sublingual nitroglycerin for the evaluation of unexplained syncope in pediatric patients

P-252 Head-up tilt testing potentiatedwith sublingual nitroglycerin for the evaluation of unexplained syncope in pediatric patients

Costs and utility of tests in the evaluation of the pediatric patients with syncope

New diagnostic tests have markedly improved the ability to establish a cause of syncope in pediatric patients, but at a substantial cost. The goal of syncope evaluation should be to diagnose treatable causes and identify patients at high risk for sudden death. The diagnostic utility of commonly used tests is reviewed. Although there are limited data on the application of specific diagnostic tests in the child with syncope, most tests have a low yield in unselected patients. A more directed approach to testing, based on the results of history, physical examination and the electrocardiogram is likely to result in significant cost reduction while still identifying patients with life threatening disorders. Validation of such an approach awaits prospective evaluation.

Pediatric neurologist as consultant in evaluation of syncope in infants and children: when to refer

The features and incidence of syncope in pediatric patients are different from those in adults. While serious medical problems may underlie the problem in children and adolescents, they tend to be less frequent, both in absolute numbers and in percentages of involved patients. This article introduces a less rigid classification compared to more classical classifications. It is the author's hope that this classification system may help define the individual in need of further, more detailed neurological evaluation and possible consultation. The importance of the history and examination in this evaluation will be emphasized.

Capnography head-up tilt test in the diagnosis of syncope in pediatric patients

Capnography head-up tilt test in the diagnosis of syncope in pediatric patients

The Role of the Capnography Head-up Tilt Test in the Diagnosis of Syncope in Children and Adolescents

To evaluate the role of the capnography head-up tilt test (CHUTT) in the diagnosis of syncope in pediatric patients. The CHUTT is a head-up tilt test with concomitant capnometry. Hyperventilation on CHUTT was diagnosed when the patient's end-tidal carbon dioxide pressure (ETPCO2) was </=25 mm Hg. Hyperventilation syncope was diagnosed when three criteria were met: loss of consciousness, ETPCO2 </=25 mm Hg, and no significant drop in blood pressure. The cohort included 65 consecutive children and adolescents (mean age, 14.2 years) who were assessed for syncope by routine investigations and CHUTT. The cause of the syncope was established in 67% of cases: cardioinhibitory reaction in 17%, vasodepressor in 20%, psychogenic in 22%, and mixed neurally mediated-psychogenic in 8% of the patients. The history indicated a cause of syncope in 40%, the CHUTT in 49%, and a combination of the history and positive CHUTT in 66% of patients. Neither the patients' clinical data nor values of the blood pressure, heart rate, respiratory rate, and ETPCO2 measured during recumbency predicted which patients would manifest hyperventilation or hyperventilation syncope on tilt. The CHUTT contributes substantially to the diagnosis of syncope in pediatric patients. The CHUTT advances the understanding of the pathophysiological mechanisms of syncope and enables the physician to reassure the patient regarding the essentially benign nature of the condition. Because it is not possible to predict which patients would develop a hyperventilation syncope on the standard tilt test, the modification of this procedure by measuring the ETPCO2 for the assessment of children with syncope should be considered.

The medical therapy of cardioinhibitory syncope in pediatric patients.

A small percentage of pediatric patients with neurally mediated syncope will have an asystolic response during upright tilt table testing. The purpose of this study is to evaluate the incidence of asystole during tilt table testing, and to assess the outcome of medical management of such patients. Of 398 patients undergoing evaluation for recurrent syncope between January 1989 and 1994, 18 (4.5%) experienced asystole lasting > or = 5 seconds during baseline tilt test. Patients had experienced a mean of four episodes of syncope, with a mean age at the time of tilt test of 11.1 +/- 4.0 years. The median duration of asystole was 10 seconds (range 5-40 s). Treatment was individualized to increased fluids and salt intake (3 patients), metoprolol (8 patients), pseudoephedrine (4 patients), disopyramide (1 patient), or combination therapy with fludrohydrocortisone (2 patients). During a median duration of follow-up of 31 months, no additional syncope was experienced by 78% of patients. Recurrent syncope in 4 patients was associated with either noncompliance or discontinuation of therapy in 3 patients; in 1 patient, increasing the dose of metoprolol was effective in preventing recurrences. We conclude that young patients with recurrent syncope and asystole during tilt test may be safely and effectively managed with pharmacological therapy, without resorting to pacemaker implantation.

Evaluation of Recurrent Pediatric Syncope: Role of Tilt Table Testing

To determine the current practice and effectiveness of evaluating recurrent syncope in pediatric patients, and to establish the role of tilt table testing in the evaluation. Retrospective analysis of 54 pediatric patients with the history of syncope referred to cardiologists. Group I consisted of 27 patients examined without tilt table testing; group II consisted of 27 patients whose examination included tilt table testing. Group I had an average of 5.4 studies and group II, 6.6 studies performed per patient. Studies included chest radiograph (16 vs 13), electrocardiogram (24 vs 27), echocardiography (21 vs 27), 24-hour electrocardiogram (14 vs 16), transtelephonic monitor (7 vs 8), electrophysiology study (1 vs 3), complete blood cell counts (11 vs 12), chemistries (10 vs 11), thyroid function test (3 vs 3), neurology consult (12 vs 6), electroencephalogram (12 vs 5), and head computed tomographic scan (5 vs 3). Of the 298 non-tilt studies, the results of only 5 (1.6%) were abnormal. Diagnoses were made in 5 (18.5%) of 27 group I patients (Wolff-Parkinson-White syndrome, 1; conversion reaction, 2; hyperventilation, 1; migraines, 1), whereas diagnosis was made in 27 (100%) of 27 group II patients (neurocardiogenic syncope, 25; conversion reaction, 2). An extensive workup is not routinely indicated in syncopal patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation will increase the probability of a diagnosis, and will often prevent the need for further extensive, expensive anxiety-producing tests.

Tilt-Table Testing and Oral Metoprolol Therapy in Young Patients With Unexplained Syncope

Tilt-table testing is useful for investigating unexplained syncope in pediatric patients. No data are available on the use of intravenous metoprolol during testing to identify children who might respond to subsequent oral beta-adrenergic blockade or on the efficacy and safety of such oral therapy. To provide these data, we obtained follow-up information on 27 consecutive pediatric patients who had tilt-table testing for unexplained syncope. Nineteen patients (70%) had positive test results with or without isoproterenol infusion. All these patients had negative test results after intravenous infusion of metoprolol and subsequently were treated with oral metoprolol. Taking oral metoprolol therapy alone, 9 (47%) of the 19 patients were asymptomatic, 8 (42%) reported a decreased frequency of syncopal episodes, and 2 (11%) had unchanged or more frequent episodes. The mean dosage of metoprolol required to prevent symptoms was 1.5 mg/kg per day. Mild side effects were reported by 6 (32%) of the 19 patients. Six patients (32%) required additional medications. We conclude that metoprolol is safe and effective for the treatment of most cases of neurocardiogenic syncope in children and that this response cannot be predicted accurately by the use of intravenous metoprolol during testing.

Carotid Sinus Syndrome and Wrestling

A 17-year-old boy who lost consciousness during wrestling matches was found to have carotid sinus syndrome. To our knowledge, this report is only the second published case of this entity in an adolescent. Herein we discuss possible implications of this finding for the assessment of syncope in pediatric patients.

Tilt test for diagnosis of unexplained syncope in pediatric patients : Thilienius OG, Quinones JA, Husayni TS, Novak J. Pediatrics. 1991;87: 334–338

Tilt test for diagnosis of unexplained syncope in pediatric patients : Thilienius OG, Quinones JA, Husayni TS, Novak J. Pediatrics. 1991;87: 334–338

Tilt Test for Diagnosis of Unexplained Syncope in Pediatric Patients

Thirty-five teenage patients with a history of presyncope or syncope underwent a passive head-up tilting to reproduce symptoms of syncope. If tilting alone did not induce syncope, isoproterenol infusion was given to increase heart rate to 150 to 160 beats per minute. In 80% of patients with a history of syncope, identical symptoms could be reproduced during tilting: an abrupt fall in blood pressure combined with profound nodal bradycardia, ranging from 32 to 86 beats per minute. These symptoms were quickly reversed by returning the patient to the supine position. For patients with frequent occurrences of syncope, especially when there was a history of trauma sustained during these episodes, a therapeutic regimen of either beta blockers or 9 alpha-fluorocortisol was begun. The mechanisms of this common cause of syncope in childhood is neurocardiogenic in response to venous pooling and catecholamine-induced tachycardia. The tilt test is an excellent and cost-effective test for the workup of unexplained syncope in childhood.