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The child with recurrent syncope: autonomic function testing and beta-adrenergic hypersensitivity.

J C Perry1, A Garson

  • 1Department of Pediatric, Baylor College of Medicine, Texas Children's Hospital, Houston.

Journal of the American College of Cardiology
|April 11, 1991
PubMed
Summary

Recurrent syncope in children with normal hearts may stem from beta-adrenergic hypersensitivity. Autonomic testing identified this in some patients, who improved with beta-blocker medication.

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Area of Science:

  • Pediatric Cardiology
  • Autonomic Neuroscience
  • Clinical Medicine

Background:

  • Recurrent syncope in children with structurally normal hearts presents diagnostic challenges.
  • Autonomic nervous system dysfunction is a potential contributor to pediatric syncope.

Purpose of the Study:

  • To investigate the role of autonomic nervous system dysfunction in children experiencing recurrent syncope.
  • To assess the efficacy of autonomic function testing in diagnosing the cause of syncope.

Main Methods:

  • Formal autonomic function testing was conducted on 22 children (aged 7-18) with recurrent syncope and normal cardiac function.
  • Testing included eight to nine separate autonomic assessments, with syncope or symptoms reproduced in 14 patients.
  • Norepinephrine levels and heart rate response to isoproterenol were analyzed in relation to test results.

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Main Results:

  • Patients with positive autonomic tests showed lower supine and upright norepinephrine levels compared to those with negative tests.
  • A steeper heart rate response slope to isoproterenol was observed in patients with positive tests.
  • Intravenous propranolol eliminated syncope in 5/5 patients, and atenolol successfully treated 8/10 patients with positive tests.

Conclusions:

  • Beta-adrenergic hypersensitivity is a potential cause of recurrent syncope in pediatric patients.
  • Abnormal heart rate responses to standing may trigger the Bezold-Jarisch reflex, leading to syncope.
  • Beta-adrenergic blockade demonstrates therapeutic benefit for many children with syncope due to autonomic dysfunction.