Syncope refers to a sudden, transient loss of consciousness due to decreased blood flow to the brain. In children and adolescents, cardiac abnormalities causing syncope are rare, and the most common causes are autonomic syncope, vasovagal syncope, and postural hypotension. Evaluation of syncope in children aims to determine if there is an increased risk of sudden cardiac death. Factors suggesting a cardiac cause include lack of prodrome, palpitations, exercise-induced syncope, family history of cardiac issues or early death, and prior known cardiac disease. These patients should be referred to a cardiologist to evaluate for potential inherited cardiac conditions like Brugada syndrome or long QT syndrome.

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4. Syncope: Sudden, transient LOC associated with an
absence of postural tone secondary to relatively abrupt
cerebral hypo perfusion
SCD: Unexpected natural death from a cardiac cause
within a short time period, generally ≤1 hour from the
onset of symptoms, in a person with a known or unknown
cardiac cause
What???
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6. Syncope: Children & adolescence
• Unlike adults: Cardiac abnormality as a cause of syncope: Rare
Autonomic syncope
Vasovagal syncope
Postural hypotension
Dyautonomia
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7. Breath-holding spells Pallid spells Cyanotic spells
6 months-6Y 1Y--2Y 6months -2Y
Iron deficency Early form of VVS VSD+ PS physiology
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8. Syncope: Evaluation to be done seriously
Main purpose is to determine whether the child
has increased risk of death
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9. Suspect cardiac
syncope
• Lack of prodrome
• Palpitations/ chest pain
• Cardiac murmur/CVS exam
• Exercise induced syncope
• Family H/o-SCD/
arrhythmia/early death
• Previous h/o of cardiac
disease
Refer to
cardiologist
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11. •BRUGADA SYNDROME
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12. Brugada syndrome
RBB pattern
ST/J point elevation / coving pattern
V1-V3 leads
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13. Management
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Quinidine
Epicardial ablation
Fever treatment

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15. •LQTS
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23. •SQTS
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24. • ICD: Therapy of choice
• Propafenone/ quinidine/
sotalol: May help prolong QTi
and decrease potential for VF
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25. •CPVT
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26. CPVT: Catecholaminergic polymorphic ventricular
tachycardia
Flecanide, Verapamil
LCSD
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27. Non cardiac
IEM
Metabolic
Downs syndrome
5% channelopathies
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29. Take home message…
• Exertional syncope: Points to cardiac cause of syncope
• All Syncope cases: Consider arrhythmia—> Get ECG done
• Inherited arrhythmias—> High index suspicion and genetic
testing of patient and family
• SCD: Warning and prodromal symptoms—> Taken seriously
and evaluated—> Prevent SCD
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30. THANK YOU…
murtaza.vmmc@gmail.com
+91-9971259799
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