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We review a general approach to syncope in children.



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Brian Gilberti, MD

Ellen Duncan, MD





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Tags: Cardiology ([ Ссылка ]) , Pediatrics ([ Ссылка ])







Show Notes




• Initial Evaluation and Management:



• Similar initial workup for children and adults: checking glucose levels for hypoglycemia and conducting an EKG.


• The history and physical exam are crucial.





• Dextrose Administration in Children:



• Explanation of the ‘rule of 50s’ for determining the appropriate dextrose solution and dosage for children.





• ECG Analysis:



• Importance of ECG in diagnosing dysrhythmias like long QT syndrome, Brugada syndrome, catecholamine polymorphic V tach, ARVD, ALCAPA, and Wolff-Parkinson-White syndrome.


• Younger children’s dependency on heart rate for cardiac output and the risk of arrhythmias in kids with congenital heart disease.











































































ConditionCharacteristic ECG FindingsCongenital/AcquiredLong QT Syndrome (LQTS)Prolonged QT intervalCongenital/AcquiredWolff-Parkinson-White Syndrome (WPW)Short PR interval, Delta waveCongenitalBrugada SyndromeST elevation in V1-V3, Right bundle branch blockCongenitalAtrioventricular Block (AV Block)PR interval prolongation (1st degree), Missing QRS complexes (2nd & 3rd degree)Congenital/AcquiredSupraventricular Tachycardia (SVT)Narrow QRS complexes, Absence of P waves, TachycardiaCongenital/AcquiredVentricular TachycardiaWide QRS complexes, TachycardiaCongenital/AcquiredArrhythmogenic Right Ventricular Dysplasia (ARVD/C)Epsilon waves, V1-V3 T wave inversions, Right bundle branch blockCongenitalHypertrophic Cardiomyopathy (HCM)Left ventricular hypertrophy, Deep Q wavesCongenitalPulmonary HypertensionRight ventricular hypertrophy, Right axis deviationAcquiredAthlete’s HeartSinus bradycardia, Voltage criteria for left ventricular hypertrophyAcquiredCatecholaminergic Polymorphic VT (CPVT)Bidirectional or polymorphic VT, typically normal at restCongenitalAnomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)May be normal, signs of ischemia or infarction in severe casesCongenital



• History Taking:



• Key aspects include asking about syncope with exertion, syncope after being startled, and syncope after pain or emotional stress.


• Prolonged loss of consciousness may indicate seizures, and emotional stress and pain can trigger breath-holding spells.





• Breath-Holding Spells:



• Clarification of misconceptions about breath-holding spells, discussing their causes and characteristics, like cyanotic and pallid types.


• Association with iron deficiency and the fact that most children outgrow these spells by age 8.





• Physical Examination and History:



• A cardiac exam is vital, with specific signs to look for, like murmurs in hypertrophic cardiomyopathy.


• History can help identify the etiology of syncope, such as vasovagal responses or orthostatic hypotension.





• Vasovagal Syncope:



• Common in kids, especially teenagers, typically presenting with a prodrome of lightheadedness, diaphoresis, and pallor.


• Normal glucose and EKG are expected in these cases.





• Additional Lab Tests:



• Pregnancy tests in reproductive-age women, and checking for less common causes like pulmonary embolism, subarachnoid hemorrhage, and toxic exposures.







Take Home Points:




• Immediate assessments for syncope in children should include a FS to evaluate for hypoglycemia and an ECG to evaluate any cardiac rhythm or conduction abnormalities.


• Apply the “Rule of 50s” for hypoglycemic patients to suggest which fluids s...

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