This month’s spotlight is Pediatric Cardiology as Contemporary Pediatrics sits down exclusively with pediatric cardiologist Cheyenne Beach, MD, assistant professor of Pediatrics, Pediatric and Adult Congenital Electrophysiology, Section of Pediatric Cardiology, Yale New Haven Children’s Hospital, New Haven, Connecticut, to discuss the one key condition for which she believes community pediatricians should be especially aware—syncope.
Q. Dr. Beach, can you tell us what syncope is and why you think it is something of particular concern for pediatricians?
A. Syncope is essentially passing out. Technically, the definition of syncope is an abrupt, transient, complete loss of consciousness with loss of postural tone. And this is something that is important for us as pediatricians to think about and talk about, first because it’s really common—about 15% of pediatric patients have at least 1 episode of syncope during their pediatric lifetime—and also because syncope can be really anxiety provoking, both for family members and friends who witness events and also for providers who know that syncope can be a symptom of a life-threatening condition.
Q. What do you think are the underlying reasons for the increase in the frequency and severity of syncope specifically in children?
A. I don’t think that there’s necessarily been an increase in episodes of syncope in children, but more and more we’re hearing publicized cases of malignant or dangerous types of syncope, so I think it’s something that has been more anxiety provoking, both for people throughout the community and again also for providers taking care of these patients.
Q. What advice could you offer as far as diagnostic clues that pediatricians should be on the lookout for to properly diagnose syncope in their patients?
A. This is a topic we can cover in a few minutes here but I feel like I could talk about this for a long time. It’s something I see pretty often in our arrhythmia clinic and I’ve become pretty accustomed to trying to use these diagnostic tools. So first, when we see patients with syncope we have to determine if thisis an episode of benign or usually vasovagal syncope or if it’s syncope from another more concerning cause. I’ll note that syncope can have a neurologic cause, something like a seizure, but I won’t focus on that today, instead really differentiating benign or vasovagal syncope versus a cardiac cause of syncope.
Cardiac causes of syncope can fall into 3 large categories and there’s a fair amount of overlap among these categories. The first is a primary arrhythmogenic cause of syncope—things like an inherited channelopathy, long QT syndrome, or something called catecholaminergic polymorphic ventricular tachycardia (CPVT). We also think of patients with Wolff-Parkinson-White (WPW) syndrome. Patients with ventricular tachycardia fall into this category. Second, there’s a structural category for patients who have a structural abnormality in their heart—things like aortic stenosis, an abnormal coronary artery, or hypertrophic cardiomyopathy. And third are patients who have a low cardiac output state, and these tend to be patients whose heart muscles aren’t functioning well due to things like cardiomyopathy from other causes such as a dilated cardiomyopathy or myocarditis. So, in thinking about these cardiac causes that are relatively rare but that we always have to have in the back of our minds, it’s important to ask a thorough detailed history about this event.