Causes of syncope in children and adolescents
- Jack C Salerno, MD
Jack C Salerno, MD
- Associate Professor, Department of Pediatrics, Division of Cardiology, Arrhythmia and Pacing Services
- University of Washington School of Medicine
- Brian Coleman, MD, MSE
Brian Coleman, MD, MSE
- Attending Physician, Georgia Emergency Physician Specialists
- Memorial Health University Medical Center
- Section Editors
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the serious and benign causes of syncope. A discussion of the emergent evaluation and algorithmic approach to children and adolescents with syncope is presented separately (algorithm 1). The evaluation of adults with syncope is also discussed elsewhere. (See "Emergent evaluation of syncope in children and adolescents" and "Syncope in adults: Clinical manifestations and diagnostic evaluation".)
Syncope is a sudden, brief loss of consciousness associated with loss of postural tone from which recovery is spontaneous . Up to 15 percent of children experience a syncopal episode prior to the end of adolescence [2,3].
Although the etiology of syncopal events in children is most often benign, syncope can also occur as the result of more serious (usually cardiac) disease with the potential for sudden death. The vast majority of cases of syncope in the pediatric age group represent benign alterations in vasomotor tone [4,5]. Life-threatening causes of syncope generally have a cardiac etiology (table 1).
Life-threatening cardiac conditions cause syncope as the result of an abrupt decrease in cardiac output, either from an arrhythmia or related to structural heart disease . Arrhythmias are typically tachyarrhythmias. In children, syncope caused by isolated bradycardia (ie, complete AV block) is uncommon . (See "Bradycardia in children", section on 'Clinical presentation'.)
Primary electrical disturbances can occur in patients with structurally normal hearts. These arrhythmias may be related to exogenous factors (ie, a metabolic disturbance or drug ingestion) or an inherited electrophysiologic abnormality (ie, congenital long QT syndrome). Arrhythmias may also develop as the result of structural heart disease, such as myocarditis or repaired congenital heart disease. Finally, syncope can occur in conditions such as aortic stenosis and hypertrophic cardiomyopathy (HCM) as the result of left ventricular outflow tract obstruction and compromised systemic blood flow, particularly during exercise.
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- LIFE-THREATENING CONDITIONS
- Primary electrical disturbances
- - Long QT syndrome
- - Brugada syndrome
- - Catecholaminergic polymorphic ventricular tachycardia
- - Preexcitation syndrome
- - Congenital short QT syndrome
- Structural heart disease
- - Hypertrophic cardiomyopathy
- - Coronary artery anomalies
- - Arrhythmogenic right ventricular cardiomyopathy
- - Valvar aortic stenosis
- - Dilated cardiomyopathy
- - Pulmonary hypertension
- - Acute myocarditis
- Heat illness
- COMMON CONDITIONS
- Vasovagal syncope
- Breath holding spells
- Orthostatic hypotension
- Toxic exposure
- OTHER CONDITIONS
- CONDITIONS THAT MIMIC SYNCOPE