Syncope, also known as fainting or sudden
loss of consciousness, is usually a benign process with
many causes, but it can be a symptom of serious cardiac disease
and can predispose to sudden death. Assessing syncope in children
is challenging due to the variability of symptoms and lack of a
gold standard for evaluation. Sudden cardiac death includes just
those causes that directly relate to cardiovascular dysfunction.
Although the main focus of this chapter is syncope and sudden death
due to cardiovascular causes, other causes of sudden death (neurologic,
respiratory, and traumatic) are also discussed.
Syncope is a presenting symptom in 0.05% of pediatric
visits1 and 6% of hospital admissions2 and
is more common in adolescents than in younger children. Between
20% and 50% of adolescents experience at least
one episode of syncope.2 Only 25% of all patients referred to a cardiology or
neurology specialty clinic for the evaluation of syncope are ultimately
diagnosed with a serious illness.3 The most common
type of benign syncope is neurally mediated (vasovagal) syncope.1 Therefore,
prior syncopal events are not always associated with an increased
risk of sudden death.4
There is a difference between sudden unexpected death and sudden
cardiac death, because the first can have many causes, such as a
seizure, asthma, or toxic ingestion. Sudden cardiac death includes
just those events that directly relate to cardiovascular dysfunction. Sudden
unexpected death in children accounts for 2.3% of all deaths,
or 1.3 cases per 100,000 patient-years.5 Sudden
cardiac death comprises approximately one third of these deaths,
or about 600 deaths per year in the U.S. Excluding trauma, sudden
cardiac death is the most common cause of sports-related death in
young athletes.6 Sports most frequently associated
with sudden death are basketball, football, and track events.6 The
greatest risk for sudden cardiac death is in patients with congenital
or acquired structural cardiac disease, including those with congenital
heart disease who have undergone corrective surgery. The most frequent
causes of sudden cardiac death in children are listed in Table 140-1.7 Hypertrophic
cardiomyopathy and myocarditis are the most common causes of sudden
cardiac death in adolescents without known cardiac disease.5,7 Sudden cardiac
death is usually an unexpected, unwitnessed, terminal event. When
resuscitation is started rapidly in patients whose cardiac arrest
is witnessed, the likelihood of survival is much greater, approaching
25%. Witnesses may be able to describe prodromal symptoms
to aid in determining the cause of the event.8
Table 140-1 Predisposing
Factors for Sudden Cardiac Death in Children |Favorite Table|Download (.pdf)
Table 140-1 Predisposing
Factors for Sudden Cardiac Death in Children
|Structural cardiac disease||Congenital heart disease (cyanotic and noncyanotic)|
|Valvular heart disease|
|Anomalous coronary arteries|
|Coronary artery disease|
|Cardiac dysfunction||Acute myocarditis|
|Cardiomyopathy (congenital and acquired)|
|Rhythm disturbances||Congenital complete heart ...|
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