Syncope (peds): Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
''For adult patients see [[syncope]]'' | ''For adult patients see [[syncope]]'' | ||
==Background== | ==Background== | ||
*Usually because of an abrupt cerebral | *Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline) | ||
*Peak age: 15-19 years of age | *Peak age: 15-19 years of age | ||
*In younger children, usually due to seizures, breath holding or cardiac disease | *In younger children, usually due to [[seizures (peds)|seizures]], [[breath-holding spell]] or cardiac disease | ||
===Red flags=== | ===Red flags=== | ||
| Line 14: | Line 14: | ||
**Unexplained deaths | **Unexplained deaths | ||
**Death due to single-vehicle accident | **Death due to single-vehicle accident | ||
**Drowning | **[[Drowning]] | ||
**[[SIDS]] | **[[SIDS]] | ||
| Line 22: | Line 22: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Seizure]] | *[[Seizure]] | ||
* | *[[Toxicologic exposure]] (stimulants or depressant) | ||
*[[CO poisoning ]] | *[[CO poisoning ]] | ||
*[[Breath-holding spell]] | *[[Breath-holding spell]] | ||
*[[Tet spell]] | *[[Tet spell]] | ||
*[[congenital heart disease|Cardiac disease]] | *[[congenital heart disease|Cardiac disease]] | ||
*Pregnancy (especially ectopic) | *[[Pregnancy]] (especially [[ectopic]]) | ||
*[[Hypoglycemia (peds)|Hypoglycemia]] | *[[Hypoglycemia (peds)|Hypoglycemia]] | ||
| Line 34: | Line 34: | ||
==Evaluation== | ==Evaluation== | ||
*[[ECG]] – looking for: | *[[ECG]] – looking for: | ||
**WPW – short PR, Delta waves, wide QRS | **[[WPW]] – short PR, Delta waves, wide QRS | ||
**Long QT syndrome – QTc >0.450 sec | **[[Long QT syndrome]] – QTc >0.450 sec | ||
**Hypertrophic | **[[Hypertrophic cardiomyopathy]] – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves | ||
**Brugada syndrome – incomplete RBBB with ST elevations in V1-3 | **[[Brugada syndrome]] – incomplete RBBB with ST elevations in V1-3 | ||
**Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave) | **[[Arrhythmogenic right ventricular dysplasia]] (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave) | ||
** Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG | **Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG | ||
*Capillary blood sugar | *Capillary blood sugar | ||
*Tox screen (urine or serum – based on clinical scenario) | *[[Tox screen]] (urine or serum – based on clinical scenario) | ||
*Beta-HCG | *Beta-HCG | ||
*Serum extended electrolytes, CBC, TSH | *Serum extended electrolytes, CBC, TSH | ||
*Bedside cardiac | *Bedside cardiac [[echocardiography]] | ||
**Cardiac hypertrophy or pericardial effusion | **Cardiac hypertrophy or [[pericardial effusion]] | ||
**Assess the IVC for dehydration | **Assess the IVC for [[dehydration]] | ||
==Management== | ==Management== | ||
Revision as of 14:43, 31 August 2019
For adult patients see syncope
Background
- Usually because of an abrupt cerebral hypoperfusion (30-50% from baseline)
- Peak age: 15-19 years of age
- In younger children, usually due to seizures, breath-holding spell or cardiac disease
Red flags
- Exercise-induced collapse
- Chest pain
- Previous cardiac surgery
- Family history of:
Clinical Features
- Abrupt loss of consciousness with full recovery after a short duration
Differential Diagnosis
- Seizure
- Toxicologic exposure (stimulants or depressant)
- CO poisoning
- Breath-holding spell
- Tet spell
- Cardiac disease
- Pregnancy (especially ectopic)
- Hypoglycemia
Syncope Causes
- Cardiovascular-mediated syncope
- Dysrhythmias:
- Cardiovascular disease
- Neurally mediated syncope
- Vasovagal:
- Fear, pain, emotion, valsalva, breath-holding spell
- Situational (associated with):
- Vasovagal:
- Orthostatic hypotension-mediated syncope:
- Volume depletion:
- Autonomic Dysreflexia
- Autonomic failure due to meds
- Other serious causes
- Stroke
- SAH
- TIA
- Vertebrobasilar Insufficiency
- Subclavian steal
- Heat syncope
- Hypoglycemia
- Hyperventilation
- Asphyxiation
- Seizure
- Narcolepsy
- Psychogenic (anxiety, conversion disorder, somatic symptom disorder)
- Toxic (drugs, carbon monoxide, etc.)
Evaluation
- ECG – looking for:
- WPW – short PR, Delta waves, wide QRS
- Long QT syndrome – QTc >0.450 sec
- Hypertrophic cardiomyopathy – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves
- Brugada syndrome – incomplete RBBB with ST elevations in V1-3
- Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3, epsilon wave is pathognomonic (up-notching of a terminal Q wave)
- Catecholaminergic polymorphic ventricular tachycardia - May present with VT/VF due to emotional stress or a regular ECG
- Capillary blood sugar
- Tox screen (urine or serum – based on clinical scenario)
- Beta-HCG
- Serum extended electrolytes, CBC, TSH
- Bedside cardiac echocardiography
- Cardiac hypertrophy or pericardial effusion
- Assess the IVC for dehydration
Management
- Directed towards reversing the cause
Disposition
- Admission if any ECG abnormality found
- Admission usually not warranted – consider admitting kids with eating disorder
- Consider discharge home with cardiology consult and strict activity restrictions if suspicion of hypertrophic cardiomyopathy in otherwise well patient with reliable caretakers
See Also
References
- Fischer and Cho. Pediatric Syncope: cases from the ED. Emerg Med clin N Am. Vol 28. 2010. Pp 501-516.