Pediatric emergency medicine trisk 1519 1519
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TABLE 76.3
CONDITIONS THAT MAY REQUIRE HOSPITALIZATION IN
PEDIATRIC SYNCOPE
Abnormal cardiovascular examination and cardiovascular disease
Drug-related syncope
Attempted suicide
Neurologic
Persistently altered mental status
Focal neurologic deficits
Recurrent seizures
Recurrent hypoglycemia
Orthostatic hypotension resistant to fluid therapy
Patients who require CPR
CPR, cardiopulmonary resuscitation.
A variety of different medications have been tried in pediatric patients with
recurrent syncope. Of these, midodrine, an α-adrenergic agonist, has shown some
of the most beneficial results in reducing symptom recurrence with few side
effects. Fludrocortisone, a mineralocorticoid, has also been used; however, its
effectiveness is uncertain in pediatric patients with orthostatic hypotension
associated with syncope. Since symptoms of depression or anxiety are common in
patients with recurrent syncope, management of potential mood disorders may be
beneficial. The treatment of POTS is challenging, and no one pharmacologic or
nonpharmacologic approach has been consistently successful. Recommendations
include education, hydration with clear, no caffeinated beverages, increased salt
intake, elevation of the head of the bed by 10 to 15 cm, and a gradual
reconditioning exercise program spaced over 3 months.
Patients with recurrent syncopal symptoms who do not improve with
conservative measures and pharmacotherapy, as well as those with a suspected
cardiac cause for syncope, should be referred to a cardiologist for further
management. Some situations may warrant hospital admission or observation of a
child with syncope ( Table 76.3 ), especially those involving persistent
cardiovascular abnormalities or neurologic deficits.
For congenital LQTSs, the mainstay of therapy is the use of a long-acting beta
blocker. Because syncope in these patients is adrenergically mediated, they are
restricted from athletic activity. The use of an implantable cardioverter-
