In most cases syncope is benign, and the patient and family should be reassured. However, sometimes it may be due to heart disease, so a correct diagnosis is important.
What is syncope?
Syncope is a transient loss of consciousness due to a decrease in cerebral blood flow, and is one of the most frequent causes of fainting in children and adolescents. About 15-50% have had syncope in their lifetime and it is rare before the age of 12 years.
Symptoms of syncope in children
According to experts in children’s cardiology, most syncope is benign or vasovagal (common syncope), i.e., it does not respond to any structural or electrical conduction alteration of the heart. They are characterized by being rapid, of short duration and spontaneous and complete recovery.
They usually occur while standing (or standing up abruptly) and after a precipitating factor:
– Fasting
– Crowded or hot places
– Feelings such as anxiety, fear or pain
– Sight of blood
However, syncope can also be a warning sign of some cardiac alteration, which we call cardiogenic syncope, and it is this that can be a warning of possible sudden death, and which obliges us to carry out a more detailed study.
Most of the benign syncopes have previous symptoms such as dizziness, skin paleness and sweating, vision of luminous spots or beeps, which warn of the imminent loss of consciousness, sometimes giving time to sit up or to warn people around.
Syncopes due to a cardiac cause manifest as sudden loss of consciousness or during exercise; they may also be accompanied by chest pain or tachycardia, and are potentially fatal. They may be due to:
– Structural alteration of the heart or coronary arteries.
– Cardiac inflammation
– Thickening of the heart walls
– Presence of scarring in the heart
Diagnosis of syncope in children
Performing a good clinical history and with normal examination and an electrocardiogram, it is sufficient to diagnose vasovagal or benign syncope, leaving more specific tests, such as chest X-ray, cardiac ultrasound, stress test, or Holter (test that records the electrical activity of the heart for 24-48 hours, trying to detect arrhythmias), for those cases in which something abnormal is suspected.
Treatment of syncope in children and recommendations
The main treatment of vasovagal syncope is prevention, avoiding all those factors mentioned above that can precipitate it, supported by a frequent intake of fluids and salt. When premonitory symptoms such as dizziness or skin pallor are detected, it is also necessary to sit down and put the head between the legs. And once established, the legs should be raised above the level of the head to increase cerebral blood flow.
Finally, the treatment of cardiogenic syncope consists of the treatment of each specific cause, ranging from surgery to correct the congenital heart disease or structural alteration of the heart, the implantation of a defibrillator inside the heart to reverse the appearance of a possible malignant tachycardia, ablation or destruction by catheterization of an anomalous electrical pathway that predisposes to arrhythmias, or simply antiarrhythmic treatment and observation.