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Syncope

Phillip Spandorfer

Approach to the Patient with Syncope

I. Definition of the Complaint

Syncope is generally thought of as a temporary, but sudden, loss of consciousness and postural tone. It is caused by a reversible interruption of cerebral function, typically due to a deficit of cerebral oxygen or glucose delivery. The deficit in oxygen delivery may be caused by decreased cardiac output, peripheral vasodilatation, or obstruction of cerebral blood flow. It is important to differentiate the episode of syncope from other etiologies that appear like syncope, such as seizure and near-syncopal episodes. Painful events, episodes of micturition or defecation, and stress frequently precede syncope. Sweating and nausea before the episode are common as well. Seizures frequently have no prodromal period, but they may be associated with an aura before the event. Seizures are frequently associated with tonic-clonic movements during the event; however, syncopal events that last 20 seconds or longer can also be associated with very brief tonic-clonic movements. Confusion after the event, prolonged return to normal state of consciousness, and unconsciousness lasting longer than 5 minutes suggest seizure activity. During near-syncopal episodes, patients feel as if they are about to lose consciousness but do not actually become unconscious.
Syncope is a common complaint in pediatrics. Approximately 15% of children have a syncopal episode by the time they reach adulthood.

II. Complaint by Cause and Frequency

Pediatric causes of syncope are generally benign, but syncope may signal serious, life-threatening causes, particularly if it is recurrent or there is a family history of sudden cardiac arrest. In children, common causes of syncope include vasovagal episodes, orthostatic hypotension, and breath-holding spells (Table 18-1). In contrast, most adult syncope has a cardiac origin. The goal in evaluating syncope is to differentiate benign causes from more worrisome etiologies (Table 18-2).

III. Clarifying Questions

• Were there any palpitations or unusual heartbeats?
 — If the child reports palpitations, then a cardiac dysrhythmia should be considered.
• Did the syncope occur with activity?
 — Syncope that occurs with activity is particularly concerning for idiopathic hypertrophic cardiomyopathy (HCM).
• Was there a prodrome?
 — Migraines and some seizure types may cause symptoms before the actual episode.
• Did the syncope happen on standing?
 — Orthostatic hypotension is associated with syncope on standing.
• Was there pain, fear, or some disturbing visual sight before the syncope?
 — Strong emotional impulses may stimulate a vasovagal response and ultimately syncope.
• Was there any seizure-like activity?
 — Brief seizure-like motor activity can occur with vasovagal syncope. Prolonged seizure activity should prompt a more thorough seizure workup. There is no significant postictal period with the seizure-like activity associated with syncope.
• How long did it take to return to baseline?
 — Vasovagal syncope is associated with a relatively quick (minutes) return to baseline mental status as soon as cerebral blood flow is restored. If there is a delay in assuming a recumbent position, there may be a longer delay in return to baseline mental status.
• Is there a history of trauma?
 — A recent history of head trauma raises concern for intracranial hemorrhage.
• Is there a history of anemia?
 — Anemic patients may be more likely to have a syncopal episode because of decreased cerebral oxygen delivery.

Pictures

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Syncope - 6094.2.png

Book Source Details

  • Book Title: Pediatric Complaints and Diagnostic Dilemmas
  • Author(s): Samir S Shah MD; Stephen Ludwig MD
  • Year of Publication: 2003
  • Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Syncope

Read excerpts from these other book chapters related to Syncope:

Medical Books Excerpts
  • COMA
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • DELIRIUM
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • DIZZINESS
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • SYNCOPE
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • Aura
  • "In a Page: Signs and Symptoms" (2004)
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  • Syncope
  • "In a Page: Signs and Symptoms" (2004)
  • [ read ]
  • Coma
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Delirium
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Syncope
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • DELIRIUM
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • DIZZINESS
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • SYNCOPE
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Aura
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Dizziness
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Syncope
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Syncope
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Aura
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Dizziness
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Syncope
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Coma
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Delirium
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Dizziness
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Syncope
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Coma
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Syncope
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Dizziness
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Syncope
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Aura
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Dizziness
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Syncope
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Aura
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Dizziness
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Syncope
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • DELIRIUM
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • DIZZINESS
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • SYNCOPE
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Syncope
  • "Pediatric Complaints and Diagnostic Dilemmas" (2003)
  • [ read ]
  • Syncope
  • "The 5-Minute Pediatric Consult" (2008)
  • [ read ]
 

Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2008 Williams & Wilkins.

More About Causes of Syncope



More About This Book:
Title: Pediatric Complaints and Diagnostic Dilemmas
Authors: Samir S Shah MD; Stephen Ludwig MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 0-7817-4188-2

 » Next page: Remember to think broadly about the differential diagnosis of syncope in children (Avoiding Common Pediatric Errors)

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