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Dysautonomia and neurocardiogenic syncope
1Department of Cardiology, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, UK. karen.mcleod@yorkhill.scot.nhs.uk
Current Opinion in Cardiology
|February 27, 2001
Summary
Childhood syncope is usually benign, stemming from autonomic nervous system issues. New classifications and treatments are emerging for this common condition, improving diagnosis and management.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Disorders
- Neurally Mediated Syncope
Background:
- Syncope is a frequent concern in pediatric populations.
- Most childhood syncope cases are benign, linked to autonomic nervous system dysregulation affecting heart rate and blood pressure.
- Neurally mediated syncope is recognized as a diverse set of conditions requiring updated classifications.
Purpose of the Study:
- To review the current understanding and classification of neurally mediated syncope in children.
- To discuss diagnostic approaches, including historical evaluation and tilt table testing.
- To outline therapeutic strategies for pediatric syncope.
Main Methods:
- Review of existing literature on childhood syncope.
- Analysis of diagnostic criteria and methodologies, including tilt testing.
- Evaluation of current and emerging treatment options.
Main Results:
- Neurally mediated syncope is a heterogeneous group of disorders.
- Accurate patient history is crucial for diagnosis; tilt testing aids when history is inconclusive but protocols vary.
- Established therapies include reassurance, Fludrocortisone, and Beta-blockers; Midodrine and SSRIs are under investigation.
Conclusions:
- Reclassification of autonomic disorders is necessary due to the heterogeneity of neurally mediated syncope.
- Careful history taking is paramount for diagnosing childhood syncope.
- While reassurance and certain medications are mainstays, further research is needed for optimal treatment, especially regarding cardiac pacing for non-bradycardic cases.