UMEM Educational Pearls

The incidence of pediatric syncope is common with 15%-25% of children and adolescents experiencing at least one episode of syncope before adulthood. Incidence peaks between the ages of 15 and 19 years for both sexes.

Although most causes of pediatric syncope are benign, an appropriate evaluation must be performed to exclude rare life-threatening disorders. In contrast to adults, vasodepressor syncope (also known as vasovagal) is the most frequent cause of pediatric syncope (61%–80%).  Cardiac disorders only represent 2% to 6% of pediatric cases but account for 85% of sudden death in children and adolescent athletes.  17% of young athletes with sudden death have a history of syncope.

Key features on history and physical examination for identifying high-risk patients include exercise-related symptoms, a family history of sudden death, a history of cardiac disease, an abnormal cardiac examination, or an abnormal ECG.

Pediatric Dysrhythmias that can cause syncope in children:
- Congenital long QT
- Brugada syndrome
- Catecholaminergic polymorphic VT
- Wolff-Parkinson-White syndrome (WPW)
- Congenital short QT
- Hypertrophic Cardiomyopathy (HCM)
- Arrythmogenic RV dysplasia.
Fischer JW, Cho CS. Pediatric syncope: cases from the emergency department. Emerg Med Clin North Am. 2010 Aug; 28(3):501-16.