[Syncope in pediatric age. Diagnostic evaluation].

Abstract

Syncope is characterized by a transient loss of consciousness and the loss of postural tone to varying degrees and intensities. The cause could be associated with cardio-vascular diseases or non-cardiovascular problems. A third group includes unexplained situations, in spite of the fact that a complete medical and laboratory examination has been performed. In this manuscript, three diagnostic protocols to be followed, depending on the degree of severity, are proposed. Patient history, physical examination and basic laboratory tests are the preliminary steps for the simple cases (Protocol I). In syncope of intermediate degree, Protocol II is recommended. This protocol consists of a complete cardiologic study (electrocardiogram, Holter monitoring, and echocardiogram), neurologic evaluation (electroencephalogram during sleep, CT scan, and magnetic resonance imaging scan) and non-invasive testing of the autonomic function, especially the tilttable test. Hemodynamic studies and electrophysiological testing (Protocol III) is indicated for patients with severe and recurrent syncope, some of which are at very high risk of sudden death. The therapy depends on the diagnostic tests. It may be as simple as a change in habits or it could include pharmacological treatment such as the use of an anti-arrhythmic agent. Some cases require pacemaker implantation, while others mandate surgical procedures.