Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope.
OBJECTIVE
This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded.


RESULTS
A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis.


CONCLUSIONS
Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Christina Y
CY
Miyake
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Kara S
KS
Motonaga
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Megan E
ME
Fischer-Colbrie
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Liyuan
L
Chen
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Debra G
DG
Hanisch
2Department of Health Research and Policy,Stanford University,Palo Alto,California,United States of America.
Raymond R
RR
Balise
3Department of Pediatrics,Texas Children's Hospital,Baylor College of Medicine,Houston,Texas,United States of America.
Jeffrey J
JJ
Kim
1Department of Pediatrics,Lucile Packard Children's Hospital,Stanford University,Palo Alto,California,United States of America.
Anne M
AM
Dubin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D013781:Texas; D018667:Tilt-Table Test
Syncope; children; diagnosis; exercise; exertion; paediatric