There are many ways to classify syncope, but the simplest is to divide the causes of syncope into 2 groups: cardiac and noncardiac etiologies. 2,3 Syncope must be distinguished from all other causes of loss of consciousness, such as seizures, head trauma, and psychiatric causes. 1 Syncope accounts for 1% to 3% of emergency department (ED) visits, with an overall incidence in the pediatric population of 0.1% to 0.5%. Fifty percent of people report an episode of syncope during adolescence. Syncope is most common in teenagers, with the incidence peaking in patients aged between 15 and 19 years. These typical episodes, however, must be differentiated from those with rare, life-threatening etiologies. In pediatric patients, syncope is most often a brief episode with complete recovery, without sequelae. Syncope is defined as a transient loss of consciousness and postural tone due to an alteration in cerebral perfusion, usually associated with spontaneous recovery. What diagnostic testing is helpful in the diagnosis of this patient? What further evaluation does she need, if any? How should she be managed? Does she need admission? Introduction Now she feels she has returned to her baseline. This has happened one other time, several years ago. The patient reports recent cold symptoms and decreased appetite. She was standing and waiting for the subway when she "felt the room closing in” and the “world going dark.” The next thing she remembers is lying on the ground with people looking down at her. As you order an ECG and a pregnancy test, you think about what else you need to do for this patient.Īn 18-year-old previously healthy adolescent girl presents after fainting. Her last menstrual period was 2 weeks ago. She has no risk factors for pulmonary embolism and no family history of early cardiac death or clotting disorders. She currently has no chest pain, but feels short of breath. This episode was witnessed by friends who state she was unconscious for a few seconds. She had her third episode of syncope today while seated on a couch. Her second episode of syncope was this morning, again, after getting up and walking. The first episode of syncope occurred the previous night after getting up from seated position and walking. She had been feeling unwell for 4 days with a dry cough, but no other cold-like symptoms. Her preceding symptoms include the sensation that her heart was racing, seeing spots in her visual fields, and feeling short of breath. Do you also need to obtain troponins, D-dimer, or coagulation studies? Does he also need an echocardiogram? You want the patient to see a cardiologist, but does this need to happen in the middle of the night?Ī 16-year-old previously healthy adolescent girl presents with multiple episodes of syncope over the last 24 hours. On physical examination, there is no evidence of acute distress, and he has normal pulmonary and cardiac examinations. He has no prior history of syncope and no recent infections. Today, he also had chest pain while running, collapsed, and had a loss of consciousness for 4 to 5 seconds. The patient reports occasional chest pain with exertion. Case PresentationsĪ 10-year-old previously healthy boy presents after “passing out” and experiencing chest pain while playing basketball with friends earlier that evening. This issue will highlight critical diseases that cause syncope, identify high-risk “red flags,” and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. Most syncope is benign, but it can be a symptom of a life-threatening condition. Syncope is a condition that is often seen in the emergency department. Brugada Syndrome Patterns On Electrocardiogram Types Of Heart Block On Electrocardiogramįigure 6. Atrioventricular Re-Entrant Tachycardia In Wolff-Parkinson-White Syndromeįigure 5. Delta Waves On Electrocardiogram Consistent With Wolff-Parkinson-White Syndromeįigure 4. Long QT Syndrome On Electrocardiogramįigure 3. Hypertrophic Cardiomyopathy On Electrocardiogramįigure 2. Management Of Various Etiologies Of Syncope Cardiac & Non Cardiacįigure 1. Red Flags - And - Green Lights - In Patients With Syncope
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