Advances in the diagnosis and therapy of syncope and palpitations in children

Although advances in diagnosis and therapy of congenital heart disease have received most of the attention, in the past few years advances in the more common troublesome problems of adolescents with syncope and palpitations have been as dramatic. Syncope may be due to a cardiac arrhythmia, but is more commonly due to an autonomic dysfunction of blood pressure control. In cases where the diagnosis is equivocal by history alone, autonomic testing, including head-up tilt table testing, may be useful. Treatment with a salt-enriched diet and a mineralocorticoid is usually effective in reducing or eliminating the incidence of syncope. In resistant cases beta-blockade, scopolamine, disopyramide, theophylline, or fluoxetine may be helpful. Palpitations are usually benign. When they are due to a supraventricular tachycardia, especially when associated with the Wolff-Parkinson-White syndrome, they may be annoying and, in those with a short refractory period, dangerous. Radiofrequency ablation of the abnormal pathway is being increasingly used to eliminate the arrhythmia and may be superior to a lifetime of pharmacologic suppression in symptomatic individuals.