Pediatric syncope


  • Usually because of an abrupt cerebral hypo-perfusion (30-50% from baseline)
  • Peak age: 15-19 years of age
  • In the 6 year old – usually due to seizures, breath holding or cardiac issue.

Red flags

  • Exercise-induced collapse
  • Chest pain
  • Previous cardiac surgery
  • Family history of:
    • Sudden Death
    • Cardiac disease at early age? or Pacemaker?
    • Drowning
    • SIDS

Clinical Features

  • Abrupt loss of consciousness with full recovery after a short duration

Differential Diagnosis


  • ECG – looking for:
    • WPW – short PR, Delta waves, wide QRS
    • Long QT syndrome – QTc >0.450 sec
    • Hypertrophic Cardiomyopathy – LVH, ST changes, T wave inversions, lateral leads needle like Q waves and absent R waves
    • Bruagada syndrome – refer to Brugada (incomplete RBBB with ST elevations in V1-3)
    • Arrhythmogenic right ventricular dysplasia (ARVD) – incomplete RBBB with T waves inversion in V1-3. Epsilon wave is pathognemonic (up-notching of a terminal Q wave)
  • Tox screen (urine or serum – based on clinical scenario)
  • Beta-HCG
  • Serum extended electrolytes, CBC, TSH
  • Bedside cardiac ultrasound
    • Cardiac hypertrophy or pericardial effusion
    • Assess the IVC for dehydration


  • Directed towards reversing the cause


  • Admission if any ECG abnormality found
  • Admission usually not warranted – consider admitting kids with eating disorder

See Also


  • Fischer and Cho. Pediatric Syncope: cases from the ED. Emerg Med clin N Am. Vol 28. 2010. Pp 501-516.