{
 "topic": "Syncope",
 "slug": "syncope",
 "category_id": 15072,
 "passage_count": 14,
 "source_chars": 11322,
 "enough_material": true,
 "references": [
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Pediatric emergency medicine (Sean M. Fox, Dale P. Woolridge (editors))",
   "author": null,
   "pages": [
    64,
    76,
    77
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    317
   ]
  },
  {
   "title": "Pediatric Decision-Making Strategies",
   "author": "Pomeranz, Albert J.",
   "pages": [
    74
   ]
  },
  {
   "title": "Caring for the Hospitalized Child",
   "author": "Section on Hospital Medicine, American Academy of Pediatrics;Jeffrey C. Gershel;Daniel A. Rauch;",
   "pages": [
    142
   ]
  },
  {
   "title": "Common Cardiac Issues in Pediatrics",
   "author": "Jonathan N. Johnson,Deepak M. Kamat",
   "pages": [
    152
   ]
  },
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    944
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    639
   ]
  }
 ],
 "passages": [
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "THOMAS B. WELCH-HORAN, ROHIT SHENOI INTRODUCTION Syncope is a sudden, brief loss of consciousness and postural tone caused by transient global cerebral hypoperfusion and characterized by complete recovery. Presyncope is a feeling of impending sensory and postural changes without loss of consciousness. Syncope is a common condition in childhood. In the United States, it accounts for about 3% of pediatric emergency department (ED) visits. The incidence peaks during the second decade of life, and about 30% to 50% of children experience syncope by the end of adolescence. Girls are more commonly affected than boys. The most common cause of syncope in children is vasovagal syncope, which is related to a loss of vasomotor tone and is generally benign. Occasionally, the etiology may be a life-threatening cardiac condition. When evaluating a child who presents to the ED with syncope, the goal is to assess whether high-risk conditions are present, or whether the symptoms can be attributed to a more benign etiology."
  },
  {
   "source": "Pediatric emergency medicine (Sean M. Fox, Dale P. Woolridge (editors)), p. 64",
   "text": "## INTRODUCTION Syncope, classically defined as a transient, self-limited loss of consciousness and postural tone,isa common presentingcomplaintinthepediatricemergencydepartment (ED). By definition, the recovery from syncope is spontaneous, rapid, prompt, and complete without any neurologic sequelae.[1] Syncope accounts for approximately 126 in 100,000 children coming to medical attention.[1] The approach to syncope and the etiologies differ from the adult population because most pediatric syncope is from non-life-threatening causes, and a minimal evaluation in the ED is appropriate with parental reassurance. Despite this generally benign prognosis, care must be made to find the more uncommon and potentially fatal causes. The primary purpose of the evaluation of the patient with syncope is to determine whether the patient is at increased risk for death and needs either admission to the hospital or an expedited outpatient evaluation.[2] ## HISTORY, EXAMINATION, AND TESTING History"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "SUMMARY POINTS Syncope is a common condition in children and is usually benign. Common causes for syncope include vasovagal syncope, breath-holding spells, and orthostatic intolerance. Life-threatening causes are usually cardiac in etiology. A comprehensive medical and family history, a thorough physical examination, and a 12-lead ECG will help identify most patients with life-threatening causes of syncope. Routine blood testing and imaging are unnecessary. Since recurrence is common, education and reassurance are important. Suggested Readings and Key References Goldenberg I, Moss AJ, Peterson DR, et al. Risk factors for aborted cardiac arrest and sudden cardiac death in children with the congenital long-QT syndrome. Circulation 2008;117:2184\u20132191. Morrow W, Berger S, Jenkins K, et al. Pediatric sudden cardiac arrest. Pediatrics 2012;129:e1094\u2013e1102. Roden DM. Long-QT syndrome. N Eng J Med 2008;358:169\u2013176."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 317",
   "text": "**Syncope** Brett R. Anderson and Anitha S. John ## **48** _yncope_ is defined as a brief, sudden loss of consciousness and _S postural tone_ as the result of a decrease in cerebral blood flow. Syncope is reported to occur at least once in 15% to 25% of children by age 18 years. The vast majority of cases are benign in etiology. Syncope, however, can be a result of more ominous conditions and should be evaluated critically. ## **ETIOLOGY AND PATHOGENESIS**"
  },
  {
   "source": "Pediatric Decision-Making Strategies, p. 74",
   "text": "7[Worrisome elements of the history include syncope that ] either occurs in a recumbent position or is associated with exercise, chest pain, or palpitations. A history of heart disease (repaired or unrepaired) or a family history of unexplained death, drowning, hypertrophic cardiomyopathy (HCM), long QT syndrome (or other arrhythmias), or pacemaker placement are worrisome. Patients with abnormal cardiac examination findings should also be referred for an urgent cardiac evaluation."
  },
  {
   "source": "Caring for the Hospitalized Child, p. 142",
   "text": "While syncope in children and adolescents is most often due to a benign etiology, careful attention is required to exclude potentially life-threatening causes, especially cardiac disease. However, the diagnostic yield of broad laboratory and imaging in pediatric syncope is relatively low, so use a thorough history and physical examination to guide testing. ## **Clinical Presentation** ## _**History**_"
  },
  {
   "source": "Common Cardiac Issues in Pediatrics, p. 152",
   "text": "132 ![](/tmp/pdf-images/pdf-0152-00.png) CHAPTER 9 ## **Syncope** **Lalitha Sivaswamy, MD, and Pooja Gupta, MD, FASE, FACC** ## **Introduction** _syncope_ is derived from the Greek word _synkoptein_ , meaning \u201cto cut short.\u201d The term It is defined as an episode of brief loss of consciousness, with concomitant loss of postural tone, followed by spontaneous recovery. Syncope is caused by transient cerebral hypoperfusion. _Near-syncope_ is the term used when the loss of consciousness is not complete. In some individuals and under certain circumstances, the phase involving complete loss of consciousness is skipped altogether, and the prodromal symptoms followed by complete recovery constitute near-syncope. ## **Etiologic Origins** In most children, the cause of syncope tends to be a disorder of autonomic imbalance or dysfunction.[1] About 10% of children with syncope have an underlying cardiac etiologic origin.[2] See Box 9-1 for common causes of syncope in the pediatric age group."
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 944",
   "text": "**Chapter 77** ## **Syncope** _Prema Ramaswamy, MD_ ## \ufffd **DEFINITION** Syncope, defi ned as a transient sudden loss of consciousness and postural tone, is a fairly common complaint in children, particularly adolescents. Presyncope is the presence of sensory and postural impairment without the actual loss of consciousness. Th e origin of the word _syncope_ is a Greek term meaning _to cut short_ or _interrupt_ . Regardless of the underlying disorder, syncope is caused by interruption of essential energy substrates to the brain, usually from a transient reduction in cerebral blood fl ow. In children and adolescents, syncope is most often benign; however, in rare cases, it can be a fi rst signal of potential sudden death, and hence identifying patients at risk is critical. Even when the cause is benign, syncope can result in injury, and it certainly provokes anxiety."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Syncope is a brief, sudden loss of consciousness and muscle tone. There are numerous causes of syncope, many of which can be detected on the basis of historical information, physical examination, and simple diagnostic tests (see Chapter 76 Syncope ). A syncopal episode can usually be distinguished from a seizure on the basis of the description. The child is typically upright before the event and often senses a feeling of light-headedness or nausea. The child then becomes pale and slumps to the ground. Syncope can sometimes be accompanied by brief seizure-like movements. The loss of consciousness is short-lived, and recovery is rapid. This is in contrast to seizures, which usually have a postictal period with sleepiness. On awakening, the child is noted to have signs of increased vagal tone, such as pallor, clammy skin, dilated pupils, and relative bradycardia. Patients with narcolepsy also experience sudden alterations in alertness, with sleep occurring suddenly and uncontrollably during the daytime. In"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 639",
   "text": "_Syncope_ is defined as a sudden transient loss of consciousness with inability to maintain postural tone. The most common cause of syncope in the normal pediatric population is **neurocardiogenic syncope** (vasovagal syncope, fainting). **Vasovagal syncope** is classically associated with a prodrome that includes diaphoresis, warmth, pallor, or feeling lightheaded and is often triggered by acute position changes or by a specific situation or event such as pain, medical procedures, or emotional distress (Table 84.1). This type of syncope is characterized by hypotension and bradycardia. Approximately 30\u201350% of children will have had a **fainting** episode before 18 years of age. The symptoms of vasovagal syncope can overlap with those of postural orthostatic tachycardia syndrome (POTS), a constellation of symptoms characterized by symptoms of rapid heart rate and supported by a positional increase in heart rate by 40 beats per minute with normal blood pressure (see Chapter 84.1)."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Autonomic syncope is the most common cause of syncope in children and adolescents, and accounts for almost 80% of cases. It belongs to a group of neurally mediated syncope conditions in which there is a brief inability of the autonomic nervous system to keep BP and sometimes heart rate at a level necessary to maintain cerebral perfusion and consciousness. Other conditions in this group include \u201csituational\u201d syncope, which may occur after micturition, defecation, hair grooming, coughing, or sneezing. The precipitating causes for vasovagal syncope include prolonged standing, a crowded and poorly ventilated environment, brisk exercise in a warm environment, severe anxiety, perceived or real pain, and fear. There are three clinical types. In the first, there is marked hypotension (vasodepressor syncope). The second type is characterized by marked bradycardia (cardioinhibitory syncope) and in the third form, there is a combination of hypotension and bradycardia. Some symptoms that herald a syncopal event include"
  },
  {
   "source": "Pediatric emergency medicine (Sean M. Fox, Dale P. Woolridge (editors)), p. 77",
   "text": "## SUMMARY Although often benign in the pediatric population, syncope can be the first presentation of a serious underlying medical condition. A detailed history and physical examination can identify a potential cause of syncope in many patients.[3] The ECG can help screen for dangerous etiologies. Routine laboratory testing often adds little to the evaluation and is not recommended routinely.[5] Concerning high-risk features, such as early SCD in the family, known or suspected heart disease, congenital cardiac abnormalities, exercise-induced syncope, syncope without prodrome, or an abnormal ECG should prompt a cardiac evaluation for the cause of the syncope. Most syncope patients may be discharged home after a careful and thorough evaluation in the ED. ## REFERENCES 1. Kanjwal K, Masudi S, Grubb BP. Syncope in children and adolescents. Adolesc Med State Art Rev 2015;26(3):692\u2013711."
  },
  {
   "source": "Pediatric emergency medicine (Sean M. Fox, Dale P. Woolridge (editors)), p. 76",
   "text": "## NON-LIFE-THREATENING ETIOLOGIES ## Vasovagal/Neurocardiogenic Syncope/Reflex Syncope Reflex syncope, also known as vasovagal and neurocardiogenic syncope, is the most common cause of syncope in the pediatric population.[58,59] Syncope associated with recent change of position, poor hydration or nutritional status, or a warm environment is most often reflex syncope.[59] Patients may report a prodrome prior syncopal event, which makes this diagnosis more likely. Patients that present without a prodrome should raise concern for a more serious cause. Patients with reflex syncope may have symptoms of increased vagal tone even after the syncopal event has resolved. These symptoms self-resolve and, without other high-risk factors, require only observation till the patient returns to normal. ## Postural Orthostatic Tachycardia Syndrome"
  },
  {
   "source": "Cover, p. 7234",
   "text": "## **DIFFERENTIAL DIAGNOSIS** In pediatric patients in whom a diagnosis of the cause of syncope is made, it is usually benign neurocardiogenic syncope. However, the differential diagnosis is large, and there are many diseases, some life-threatening, that may present as a syncopal episode ( **Table 481-7** ). ## **TABLE 481-7 DISEASES THAT MAY PRESENT AS SYNCOPE** ![](/tmp/pdf-images/pdf-7235-00.png)"
  }
 ]
}