Syncope in Children Core EM - Emergency Medicine Podcast

We review a general approach to syncope in children.

Hosts:

Brian Gilberti, MD

Ellen Duncan, MD







https://media.blubrry.com/coreem/content.blubrry.com/coreem/Syncope_in_Children.mp3







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Tags: Cardiology, Pediatrics











Show Notes



* Initial Evaluation and Management:



* Similar initial workup for children and adults: checking glucose levels for hypoglycemia and conducting an EKG.

* The history and physical exam are crucial.





* Dextrose Administration in Children:



* Explanation of the ‘rule of 50s’ for determining the appropriate dextrose solution and dosage for children.





* ECG Analysis:



* Importance of ECG in diagnosing dysrhythmias like long QT syndrome, Brugada syndrome, catecholamine polymorphic V tach, ARVD, ALCAPA, and Wolff-Parkinson-White syndrome.

* Younger children’s dependency on heart rate for cardiac output and the risk of arrhythmias in kids with congenital heart disease.













Condition

Characteristic ECG Findings

Congenital/Acquired









Long QT Syndrome (LQTS)

Prolonged QT interval

Congenital/Acquired





Wolff-Parkinson-White Syndrome (WPW)

Short PR interval, Delta wave

Congenital





Brugada Syndrome

ST elevation in V1-V3, Right bundle branch block

Congenital





Atrioventricular Block (AV Block)

PR interval prolongation (1st degree), Missing QRS complexes (2nd & 3rd degree)

Congenital/Acquired





Supraventricular Tachycardia (SVT)

Narrow QRS complexes, Absence of P waves, Tachycardia

Congenital/Acquired





Ventricular Tachycardia

Wide QRS complexes, Tachycardia

Congenital/Acquired





Arrhythmogenic Right Ventricular Dysplasia (ARVD/C)

Epsilon waves, V1-V3 T wave inversions, Right bundle branch block

Congenital





Hypertrophic Cardiomyopathy (HCM)

Left ventricular hypertrophy, Deep Q waves

Congenital





Pulmonary Hypertension

Right ventricular hypertrophy, Right axis deviation

Acquired





Athlete’s Heart

Sinus bradycardia, Voltage criteria for left ventricular hypertrophy

Acquired





Catecholaminergic Polymorphic VT (CPVT)

Bidirectional or polymorphic VT, typically normal at rest

Congenital





Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)

May be normal, signs of ischemia or infarction in severe cases

Congenital









* History Taking:



* Key aspects include asking about syncope with exertion, syncope after being startled, and syncope after pain or emotional stress.