Diagnostic Delays and Characteristics of Pediatric Pulmonary Hypertension Presenting as Syncope

Recurrent syncope in a 16‐year‐old boy

“…However, syncope in children has several more sinister entities in the differential included under neurologic, vascular and cardiac umbrellas as discussed previously; therefore, it is crucial to fully evaluate these patients and rule out more serious causes of syncope. A recent cohort study found that 72% of patients had recurrent syncopal events, 83% presented with exertional dyspnoea and 27% with chest pain all of which should raise red flags as they are not common in vasovagal syncope 6 . A crucial finding on physical exam is the presence of a loud P2 which was identified in 68% of children with pulmonary arterial hypertension 6 …”

“…Given how ubiquitous paediatric syncope can be in the ED, it is worthwhile discussing syncope as it relates to PE and pulmonary arterial hypertension in this case. Paediatric patients seeking emergency medical care with syncope as the chief complaint can be as common as 126 per 100 000 patients with the peak incidence age of presentation between 15 and 19 5,6 . Vasovagal syncope is by far the most common aetiology of paediatric syncope being responsible for up to 80% of cases 7 .…”

“…Paediatric patients seeking emergency medical care with syncope as the chief complaint can be as common as 126 per 100 000 patients with the peak incidence age of presentation between 15 and 19. 5,6 Vasovagal syncope is by far the most common aetiology of paediatric syncope being responsible for up to 80% of cases. 7 However, syncope in children has several more sinister entities in the differential included under neurologic, vascular and cardiac umbrellas as discussed previously; therefore, it is crucial to fully evaluate these patients and rule out more serious causes of syncope.…”

“…A recent cohort study found that 72% of patients had recurrent syncopal events, 83% presented with exertional dyspnoea and 27% with chest pain all of which should raise red flags as they are not common in vasovagal syncope. 6 A crucial finding on physical exam is the presence of a loud P2 which was identified in 68% of children with pulmonary arterial hypertension. 6 Current treatment recommendations for PE in paediatric populations are derived from adult guidelines due to the limited available evidence in children.…”

“…6 A crucial finding on physical exam is the presence of a loud P2 which was identified in 68% of children with pulmonary arterial hypertension. 6 Current treatment recommendations for PE in paediatric populations are derived from adult guidelines due to the limited available evidence in children. The American Society of Hematology suggests thrombolysis followed by anticoagulation in patients with PE and hemodynamic compromise and recognises the necessity of thrombectomy in serious cases but does not recommend thrombectomy for routine cases.…”