Pediatric emergency medicine trisk 1516 1516
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drug ingestion or cardiac manifestations of eating disorders or central nervous
system trauma, but can also be seen in healthy adolescents. Syncope is
uncommon in patients with first- or second-degree heart block, but complete heart
block can potentially lead to more serious symptoms. The combination of history,
physical examination, and ECG allows identification of a cardiac cause of
syncope in a majority of affected children, with reported sensitivity as high as
96%. Patients with clinical features or ECG findings suggestive of heart disease
should be referred to a cardiologist.
TABLE 76.2
ECG FINDINGS IN IMPORTANT CARDIAC CAUSES OF PEDIATRIC
SYNCOPE
Cause
ECG findings
Long QT syndrome QTc >450 msec; morphology of QT segment and T wave
may vary in different genetic subtypes
Brugada syndrome Elevated ST segments in precordial leads V1 and V2.
Coving seen in Type 1 syndrome; right bundle branch
block
Wolff–Parkinson– Classic triad of delta wave, shortened PR interval, and
White syndrome
widened QRS complex. There is a slurring in upstroke
of R wave. Secondary ST-segment–T-wave changes are
directed opposite to the major delta wave and QRS
complex changes
Hypertrophic
The most frequent abnormalities found are large amplitude
obstructive
QRS complexes and associated ST-segment and T-wave
cardiomyopathy
changes consistent with left ventricular hypertrophy.
(HOCM)
Deep, narrow Q waves in leads II, III, aVF, V5, and V6
are most characteristic and specific findings of HOCM.
Left atrial enlargement is also seen
Bradycardia
Second- and third-degree heart block
To summarize, risk factors for a cardiac etiology for syncope include the
absence of prodromal symptoms, palpitations that occur seconds before loss of
consciousness, lack of a prolonged upright posture, exertion-related syncope or
syncope that occurs with auditory or emotional stimuli, a family history of sudden
cardiac death, abnormal physical examination, and abnormal ECG. Patients with
