Consultation with the Specialist: Palpitations, Syncope, and Sudden Cardiac Death in Children: Who’s at Risk?

Anjan S. Batra; Arno R. Hohn

doi:10.1542/pir.24-8-269

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Anjan S. Batra, MD*
Arno R. Hohn, MD^†

^*Division of Cardiology, Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
^†Division of Cardiology, Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, CA

Objectives

After completing this article, readers should be able to:

Clarify the definition and terminology of palpitations, syncope, and sudden cardiac death (SCD).
Differentiate the relatively benign forms of palpitations and syncope from those that are associated with an increased risk of SCD.
Characterize the evaluation for palpitations of cardiac origin.
Describe the management of neurally mediated syncope.
Discuss the structural heart diseases predisposing to sudden death.
Define the guidelines for participation in competitive athletics for children who have common cardiac problems.

Case Reports

Patient 1

A 12-year-old female, who has a history of palpitations and exertional syncope, fainted while swimming. Her brother was near her and pulled her out of the water. The girl immediately regained consciousness and was found to have normal perfusion. The family history was significant for unexplained sudden death of the girl’s older brother. Findings on physical examination of the patient were normal. Results of chest radiography were normal, but electrocardiography (ECG) revealed a sinus rhythm, with a corrected Q-T interval of 0.52 seconds.

Patient 2

A 16-year-old cross country runner had experienced several episodes of syncope. Each time she was caught prior to falling and was able to resume activities after some rest. Findings on her past medical history and family history were not significant. Physical examination results were normal. Chest radiography and ECG findings were normal, but a tilt table test showed onset of near-syncope accompanied by a significant decrease in the heart rate and blood pressure. The patient was started on a regimen of increased fluid intake and salt tablets prior to exercise. She has had no recurrences of syncope.

Overview

Palpitations and syncope are frequent presenting complaints to the pediatrician. Although mostly benign, these worrisome symptoms may be the prodrome of significant cardiac events. The devastating result could be brain damage or SCD. It is important to differentiate the …