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[Syncope in children and adolescents].

Matthias J Müller1, Thomas Paul2

  • 1Klinik für Pädiatrische Kardiologie und Intensivmedizin, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.

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Most childhood syncope (fainting) is neurally mediated and benign. Early identification through history, physical exam, and ECG helps distinguish it from rare cardiac causes, with lifestyle changes and medication often effective for neurally mediated syncope.

Keywords:
Loss of consciousnessMidodrineNeurally mediated syncopePathomechanismsShort-term global cerebral hypoperfusion

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Area of Science:

  • Pediatrics
  • Cardiology
  • Neurology

Background:

  • Syncope is a frequent occurrence in pediatric populations.
  • Neurally mediated syncope, encompassing breath-holding spells, vasovagal, and neurocardiogenic syncope, represents approximately 75% of cases due to a shared pathomechanism.
  • A small percentage (up to 6%) of syncope cases may stem from serious cardiac etiologies.

Purpose of the Study:

  • To outline the diagnostic approach to syncope in children and adolescents.
  • To differentiate between benign and potentially life-threatening causes of syncope.
  • To review management strategies for pediatric syncope.

Main Methods:

  • Detailed patient history and physical examination.
  • 12-lead electrocardiogram (ECG) for initial assessment.
  • Tilt-testing employed when diagnostic uncertainty persists.

Main Results:

  • History, physical examination, and ECG effectively distinguish between benign and serious syncope in most pediatric cases.
  • Neurally mediated syncope management primarily involves patient/family education, lifestyle modifications, and reassurance.
  • Medications like midodrine are effective for refractory neurally mediated syncope, while fludrocortisone and cardiac pacing are options for select patients. Beta-blockers are not recommended.
  • Cardiac syncope necessitates specific, disease-targeted therapeutic interventions.

Conclusions:

  • Neurally mediated syncope is the predominant cause of fainting in children and adolescents and is typically benign.
  • A systematic diagnostic approach including ECG is crucial for identifying serious cardiac causes.
  • Effective management strategies exist for both neurally mediated and cardiac syncope in pediatric patients.