SYNCOPE IN CHILDRENS #SYNCOPE

1. ASHMAL

2. SYNCOPE
 Syncope, or fainting, is the abrupt loss of consciousness
and postural tone resulting from transient global cerebral
hypoperfusion, followed by complete spontaneous
recovery.
EPIDEMIOLOGY
-Syncope is a presenting symptom in 1% to 3% of pediatric
emergency
 -80% of pediatric fainting is neurocardiogenic.
 Neurologic disorders, mostly seizures, account for about
10% of episodes
 2% to 3% are due to cardiac pathology

4.  HISTORY
 History focused on hydration status, last meal,
environmentalconditions, activity preceding the
syncopal event, and the use of drugs and medications.
 Position and activity of child
 warmth, nausea, lightheadedness,and a visual gray-
out or tunneling of vision is indicative of benign
neurocardiogenic syncope.
 Loss of consciousness occurs with the onset of
movements in seizures, but loss of consciousness
precedes movements in most cases of true
syncope
 Past and family history

5. LABORATORY EVALUATION
 ECG
 CXRAY
 TFT
 CBC

6.  SUDDEN DEATH
 7.5 cases per 100,000 children

7.  ORTHOSTATIC SYNCOPE
A drop of>20 mm Hg in blood pressure with an increase
in heart rate of >20 beats/min when the child changes
from a supine position to a standing position is often
considered diagnostic of orthostatic hypotension.
 anemia,dehydration, and use of certain medications,
especially calcium channel blockers and angiotensin-
converting enzyme inhibitors.
 SITUATIONAL SYNCOPE
Urination, defecation, coughing, and swallowing
 Stretching,neck extension, external neck pressure, and
hair grooming also havebeen described as causing
syncope, presumably due to carotid
sinushypersensitivity or abnormal Valsalva responses.

8.  HYPERTROPHIC CARDIOMYOPATHY
 Exertional syncope, congestive heart failure and
cyanosis
 loud crescendo-decrescendo murmur may be heard at
the left sternal border
 Ecg-left ventricular hypertrophy.