Unusual Cause of Recurrent Syncope in a Child (original) (raw)
Related papers
Diagnostic dilemma of cardiac syncope in pediatric patients
Indian pacing and electrophysiology journal, 2008
Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests. Retrospective study conducted at a tertiary referral arrhythmolology service The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 +/- 3.82(3.5-16) years were reviewed by the investigators. Statistical Package of social science (SPSS) version 9,0 was used for analysis of data. The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal....
Pediatrics International, 2002
Background : Arrhythmias are among the malignant causes of syncope. This study has been undertaken to determine the relative incidence and significance of dysrhythmia in the pathogenesis of syncope among patients referred to a pediatric cardiology unit. Methods : Between March 1997 and March 1999, 105 consecutive patients (59 female, 46 male) aged 11.5 ± 3.6 years without neurologic or cardiac morphologic causes were evaluated for at least one episode of syncope. A pediatric cardiologist and a pediatric neurologist evaluated all the patients. Routine chest X-ray, 12-lead electrocardiogram (ECG), electroencephalography (EEG), 24-h Holter monitoring and echocardiography were carried out. When deemed necessary, further tests were undertaken for the cases of syncope which were unexplained by routine tests. Results : The cause of syncope was identified as vasovagal in 25.7% ( n = 27) and related to dysrhythmia in 30.5% ( n = 32). The cause was migraine-associated syncope in two children, psychogenic syncope in three children and orthostatic hypotension in one patient. The cause was unknown in 36.2% ( n = 38). Conclusion : We conclude that dysrhythmia is a significant and frequent cause in children referred to pediatric cardiology units. The combination of ECG, Holter monitoring, electrophysiologic study, transtelephonic ECG and head-up tilt test can identify the underlying cause of syncope in as many as 58% of these patients that present with syncope.
Journal of Cardiovascular Electrophysiology, 2010
This 11-year-old previously healthy female began having syncopal episodes at rest and during exertion. Baseline ECG (PR interval = 155, QRS duration = 85, and QTc = 389 ms) and echocardiogram were normal. During 24-hour ambulatory heart rhythm monitoring, there were several episodes of paroxysmal high grade AV block not associated with symptoms ( ). During block, the maximum RR interval was 2.8 seconds, when the P wave rate was stable at 105 bpm. A diagnostic electrophysiologic study was performed under propofol anesthesia. Standard quadripolar electrode catheters having 2-5-2 interelectrode spacing were placed in the high right atrium, right ventricular apex, and His bundle regions. At baseline, a "split His bundle" electrogram (denoted as H-H') was always present during sinus rhythm and atrial pacing, with a constant H'V interval of 35-38 ms. During atrial extrastimulus testing and incremental atrial pacing, the AH and AH' intervals increased similarly with a nearly constant H-H' and without classic criteria for dual AV nodal physiology. What do you think is the mechanism of block?
A Rare Cause of Recurrent Syncope in the Pediatric Patient
2017
A previously healthy 4-year-old boy was admitted to hospital for two brief episodes of loss of consciousness. In addition, we note symptoms suggesting a respiratory infection. There was no anemia and no electrolyte imbalance. The child had no neurological symptoms, emergency cerebral CT and EEG were normal. There was however an inappropriate degree of tachycardia, muffled heart sounds and the ECG showed low voltage. Emergency echocardiography showed only mild circumferential pericardial effusion, but also right atrial collapse. NSAID therapy (ibuprofen) was immediately initiated, with no response. It was later replaced with low-dose corticosteroid (prednisone) therapy which resulted in slow, but steady decrease of fluid amount. The patient did not experience recurrent syncope and the pericardial effusion resolved completely during follow-up. Although syncope in children is usually reflex and thus benign, unexplained recurrent syncope should prompt a thorough evaluation including car...