Episode 192: Syncope in Children

We review a general approach to syncope in children.
Hosts:
Brian Gilberti, MD
Ellen Duncan, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Syncope_in_Children.mp3



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Tags: Cardiology, Pediatrics





Show Notes

* Initial Evaluation and Management:

* Similar initial workup for children and adults: checking glucose levels for hypoglycemia and conducting an EKG.
* The history and physical exam are crucial.


* Dextrose Administration in Children:

* Explanation of the ‘rule of 50s’ for determining the appropriate dextrose solution and dosage for children.


* ECG Analysis:

* Importance of ECG in diagnosing dysrhythmias like long QT syndrome, Brugada syndrome, catecholamine polymorphic V tach, ARVD, ALCAPA, and Wolff-Parkinson-White syndrome.
* Younger children’s dependency on heart rate for cardiac output and the risk of arrhythmias in kids with congenital heart disease.






Condition
Characteristic ECG Findings
Congenital/Acquired




Long QT Syndrome (LQTS)
Prolonged QT interval
Congenital/Acquired


Wolff-Parkinson-White Syndrome (WPW)
Short PR interval, Delta wave
Congenital


Brugada Syndrome
ST elevation in V1-V3, Right bundle branch block
Congenital


Atrioventricular Block (AV Block)
PR interval prolongation (1st degree), Missing QRS complexes (2nd & 3rd degree)
Congenital/Acquired


Supraventricular Tachycardia (SVT)
Narrow QRS complexes, Absence of P waves, Tachycardia
Congenital/Acquired


Ventricular Tachycardia
Wide QRS complexes, Tachycardia
Congenital/Acquired


Arrhythmogenic Right Ventricular Dysplasia (ARVD/C)
Epsilon waves, V1-V3 T wave inversions, Right bundle branch block
Congenital


Hypertrophic Cardiomyopathy (HCM)
Left ventricular hypertrophy, Deep Q waves
Congenital


Pulmonary Hypertension
Right ventricular hypertrophy, Right axis deviation
Acquired


Athlete’s Heart
Sinus bradycardia, Voltage criteria for left ventricular hypertrophy
Acquired


Catecholaminergic Polymorphic VT (CPVT)
Bidirectional or polymorphic VT, typically normal at rest
Congenital


Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)
May be normal, signs of ischemia or infarction in severe cases
Congenital




* History Taking:

* Key aspects include asking about syncope with exertion, syncope after being startled, and syncope after pain or emotional stress.