Abstract

Background: Various causes can lead to a transient decrease in consciousness, which can be traumatic or non-traumatic. Non-traumatic causes include syncope, seizures, and metabolic disorders. Syncope is a common problem in children. The aim of the present study was cardiac findings in patients with syncope referred to a pediatric clinic.

Methods: This is a cross-sectional study of children who referred to the clinic of Tabriz Children's Hospital with at least one episode of syncope. Patients data including number of syncope events, factors leading to syncope (including prolonged standing, hyperventilation, mental stress, exercise, and prolonged starvation); Any aura before syncope (including confusion, palpitation, decreased vision, nausea, sweating, and paleness); Patient medications and family history (including syncope, sudden death, and cardiovascular disease) were recorded. The patient's clinical examination information including heart rate, systolic and diastolic blood pressure in the supine and sitting position (after standing for 2 minutes) was recorded. Cardiopulmonary findings were recorded. 12-lead electrocardiography was performed for patients and information including heart rhythm, heart rate, P wave voltage, QRS length, heart axis and QTc were recorded. If there is a positive electrocardiographic or clinical result, 2D Doppler echocardiography was performed for patients and the results were recorded.

Findings: In this cross-sectional study, 100 children who referred to the clinic of Tabriz Children's Hospital with at least one episode of syncope were enrolled. The mean age of the children was 8.54 ± 2.70 years ranging from 2.5 to 16 years. The average number of syncope episodes at the time of study was 4 syncope with a range between 1 and 12 syncope. In terms of gender distribution, 44 children (44%) were boys and 56 children (56%) were girls. The family history of syncope was positive in 7 children (7%). The most common cause of syncope in children studied was syncope following exercise (33%). The most common aura was palpitation with a frequency of 29%. In the studied children, abnormal ECG was observed in 11 children (11%). Abnormalities included prolonged QTc in 4 cases, ventricular hypertrophy based on high voltage in 2 cases, atrial enlargement in 2 cases, abnormal axis in 1 case, complete heart block in 1 case, and supraventricular tachycardia in 1 case.

Conclusion: The use of an appropriate history and clinical examination along with ECG is of great value in the diagnosis of syncope with cardiovascular causes in children. It is also best to have echocardiography instead of echocardiography for all patients who are suspected and have an abnormal ECG. It was also observed in this study that the main defaults of cardiac syncope include early syncope with common periods, abnormal ECGs, and higher sitting and standing blood pressure differences.

Keywords: Syncope; Vasovagal Disorder; Children; Mortality; Cardiac Syncope

References

1. Gupta A., et al. “Screening Pediatric Patients in New-Onset Syncope (SPINS) Study”. Clinical Pediatrics (2020): 0009922819885660.
2. Takatsuki S., et al. “Clinical effects of syncope on disease severity and adverse outcomes in children with idiopathic and heritable pulmonary arterial hypertension”. Pediatric Cardiology1 (2019): 209-214.
3. Fadnis M., et al. “Syncope in children clinicoetiological correlation”. International Journal of Contemporary Pediatrics 6 (2019): 2622.
4. Shen WK., et al. “Ghidul privind diagnosticul şi managementul”. European Heart Journal 30 (2009): 2731-2671.
5. Wolff GS. “Unexplained syncope: clinical management”. Pacing and Clinical Electrophysiology8 (1997): 2043-2047.
6. Hueston WJ and Hebbar AK. “Cardiovascular Emergencies”. Family Medicine: Springer (2003): 684-692.
7. Gourishankar A., et al. “Demographic and clinical features of pediatric patients with orthostatic intolerance and an abnormal head-up tilt table test; A retrospective descriptive study”. Pediatrics and Neonatology1 (2020): 68-74.
8. Bilici M., et al. “Prolonged QT dispersion is associated with pediatric syncope”. The Turkish Journal of Pediatrics1 (2019): 85-91.
9. Serletis A., et al. “Vasovagal syncope in medical students and their first-degree relatives”. European Heart Journal16 (2006): 1965-1970.
10. Sadanand A., et al. “Syncope in a 16-year-old Girl”. Pediatrics In Review (2019).
11. Brignole M., et al. “A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals”. European Heart Journal 1 (2006): 76-82.
12. Ohanisian L., et al. “An Unusual Presentation of Arteriovenous Malformation in a Pediatric Patient”. Cureus 3 (2019).
13. Tanel RE and Walsh EP. “Syncope in the pediatric patient”. Cardiology Clinics2 (1997): 277-294.
14. Das BB and Chan K-C. “Syncope in a Child with Pulmonary Hypertension and Positive Gene Tests for Hereditary Hemorrhagic Telangiectasia and Long QT Syndrome”. Cardiovascular and Hematological Agents in Medicinal Chemistry (2019).
15. Brignole M., et al. “A controlled trial of acute and long-term medical therapy in tilt-induced neurolly mediated syncope”. The American Journal of Cardiology 3 (1992): 339-342.
16. Roncon L., et al. “Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism”. European Journal of Internal Medicine 54 (2018): 27-33.
17. Massin MM., et al. “Syncope in pediatric patients presenting to an emergency department”. The Journal of Pediatrics 2 (2004): 223-228.
18. Driscoll DJ., et al. “Syncope in children and adolescents”. Journal of the American College of Cardiology5 (1997): 1039-1045.
19. Ritter S., et al. “What is the yield of screening echocardiography in pediatric syncope?” Pediatrics 5 (2000): e58-60e.
20. Steinberg LA and Knilans TK. “Syncope in children: diagnostic tests have a high cost and low yield”. The Journal of Pediatrics3 (2005): 355-358.
21. Kilic A., et al. “Dysrhythmia as a cause of syncope in children without neurological or cardiac morphological abnormalities”. Pediatrics International4 (2002): 358-362.
22. Massin M. “Diagnosis and treatment of vasovagal syncope in the child and adolescent”. Archives de Pediatrie: Organe Officiel de la Societe Francaise de Pediatrie8 (1998): 923-926.
23. Chen-Scarabelli C and Scarabelli TM. “Neurocardiogenic syncope”. BMJ 329.7461 (2004): 336-341.
24. Johnsrude CL. “Current approach to pediatric syncope”. Pediatric Cardiology6 (2000): 522-531.
25. Massin MM. “Neurocardiogenic Syncope in Children”. Pediatric Drugs5 (2003): 327-34.
26. Sun BC., et al. “Inconsistent electrocardiographic testing for syncope in United States emergency departments”. The American Journal of Cardiology10 (2004): 1306-1308.
27. Lerman-Sagie T., et al. “A prospective evaluation of pediatric patients with syncope”. Clinical Pediatrics 2 (1994): 66-70.

Citation

Citation: Akbar Molaei., et al. “Cardiac Findings in Childhood Syncope". Acta Scientific Paediatrics 5.6 (2022): 14-20.

Copyright

Copyright: © 2022 Akbar Molaei., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.