Diagnostic dilemma of cardiac syncope in pediatric patients.
OBJECTIVE
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.


METHODS
Retrospective study conducted at a tertiary referral arrhythmolology service


METHODS
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.


METHODS
Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.


RESULTS
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. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.


CONCLUSIONS
Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes) and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope.
Hegazy
Ranya A
RA
Department of Pediatrics, Faculty of Medicine, Cairo University.
Lofty
Wael N
WN
Ammar
Rasha I
RI
Fattouh
Aya M
AM