Pediatric emergency medicine trisk 1509 1509
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the outflow of the left ventricle, creating a functional obstruction. In addition,
anterior motion of the mitral valve into the left ventricle during systole further
compromises outflow. Patients may present with dyspnea, exercise intolerance,
angina, syncope, or sudden death.
Adult congenital heart disease survivors are at risk for syncope because of the
underlying cardiac condition and/or previous palliative/corrective surgeries.
These patients can present with heart failure, arrhythmias, or pulmonary
hypertension. It is important to exclude atrial arrhythmias in patients with
syncope and congenital heart conditions or surgeries associated with a risk of
atrial rhythm abnormalities (e.g., tetralogy of Fallot, Ebstein anomaly, and the
Mustard, Senning, and Fontan procedures).
Other Arrhythmias
Supraventricular tachycardia is the most common symptomatic pediatric
tachyarrhythmia, and syncope can theoretically result from compromised cardiac
output, though such presentations are rarely seen. First-degree heart block may be
an incidental finding in patients with syncope. However, second- and third-degree
heart block need further investigation. Search for evidence of myocarditis,
cardiomyopathy, or congenital heart disease when such arrhythmias are observed.
Conduction disturbances are common after cardiac surgery. Patients who have
undergone correction of tetralogy of Fallot, aortic stenosis, and transposition of
the great arteries may be particularly prone to syncope. Ventricular arrhythmias
may occur as a consequence of surgeries involving incision to the ventricles.
Rarely, direct blunt trauma to the chest (commotio cordis) may cause ventricular
arrhythmias leading to syncope or sudden death.
OTHER CONDITIONS AND THOSE THAT MIMIC SYNCOPE
There are several other conditions that may cause or mimic syncope. The most
frequent of these are seizures and migraine. The rest are less frequent but still
important conditions.
Hypoglycemia
Low blood sugar is usually associated with feelings of weakness, diaphoresis,
lightheadedness, and confusion that can mimic presyncope. Infants may present
with lethargy or jitteriness. Diagnosis is rapidly established by obtaining a blood
glucose level.
Epilepsy
