Syncope in childhood

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…Although V VS is the most common cause of pediatric syncope, cardiac syncope does represent 1.5% to 6% of pediatric cases (usually defined as up to 18 years of age). 617,619,620,629,631,632 Characteristics of presenting signs and symptoms differentiating V VS from cardiac causes of syncope are generally similar to those in adults. A family history of V VS and early SCD should be sought.…”

“…By 18 years of age, it is estimated that 30% to 50% of children experience at least 1 fainting episode, and syncope accounts for 3% of all pediatric ED visits. [617][618][619][620][621][622] The incidence is higher in females and peaks between 15 to 19 years of age. 617 Neurally mediated syncope accounts for 75% of pediatric syncope, followed by psychogenic or unexplained syncope in 8% to 15% of cases.…”

Guidelines on Management (diagnosis and treatment) of syncope ? update 2004

“…In young patients, syncope may, however, also be an initial manifestation of rare but life-threatening conditions like the long QT syndrome [376], KearnseSayre syndrome (external ophthalmoplegia and progressive heart block), Brugada syndrome [203], atrial fibrillation in patients with the WolffeParkinsoneWhite syndrome [377], catecholaminergic polymorphic ventricular tachycardia [378], right ventricular dysplasia [379], arrhythmias after repair of congenital heart disease [380], hypertrophic cardiomyopathy, anomalous coronary artery, pulmonary arterial hypertension or myocarditis. There are numerous 'warning bells' from the history that should indicate a potentially life-threatening cause [381,382]. These are: syncope in response to loud noise, fright, or extreme emotional stress syncope during exercise syncope while supine family history of sudden death in young person !30 years old.…”

“…The mainstay of management of neurally-mediated syncope in childhood includes reassurance, education, behaviour modification [381,382], salt and increased fluids [384,386]. Drinking enough salty or sweet liquid without caffeine, ruling out salt avoidance and performing 'anti-gravity manoeuvres' at the earliest recognition of presyncope [328,387] is helpful in many patients (Level B).…”

Symptoms, Signs, and EEG Changes During Reflex Syncope

“…Recognized usually by the pattern of symptoms and signs only, the present study provides a correlation between symptoms, signs, video and EEG data, leading toward a more definite diagnosis. Vasovagal syncope is differentiated from other, rare causes of syncope, including cardiac (ventricular tachycardia, long QT syndrome, Wolff-Parkinson-White syndrome, and atrioventricular block), and non-cardiovascular pseudo-syncopes (reflex anoxic seizures or psychogenic causes) [2].…”