Clinical manifestations of syncope in children depending on the type of cardiovascular disease

Abstract

Syncope in children is a topical multidisciplinary medical and social problem all over the world. Syncope occurrence in children population is about 15%. Despite modern equipment of European clinics it is not possible to determine the cause of syncope in about 1/3 of cases. Our objective was to determine special features in clinical presentation of cardiovascular syncope in children. The study was conducted on 144 children (80 females, 64 males) from 2 to 18 years with diagnosed syncope of cardiovascular origin. Methods of vibrational and alternative statistics were used to perform research data analysis using licensed program package “MedStat” (serial number MS 000065) Structure of cardiovascular syncope causes was the following: prevalence of vasovagal syncope was 72,9±3,7 %, prevalence of heart rate and conduction abnormalities was 22,2±3,5 %, prevalence of structural heart pathology was 4,9±1,8%. In all patients cardiovascular disease was diagnosed first time in their life. This indicates insufficient awareness level of physicians about differential diagnostic algorithm of pathology which cause syncope in children. The length of syncopal anamnesis in children was varied from 1 month to 6 years. Only 16,7±3,1 % of cardiovascular pathology was diagnosed within first 6 months after first syncope episode, 47,9±4,2 % of cardiovascular pathology was diagnosed after 3 and more years. In 82,6±3,2 % of patients cause of syncope was established after few years. Prevalent cause of late diagnosed syncope in children with cardiovascular pathology was vasovagal syncope: in 55,2±4,9 % of patients after 3 years and more from the first syncope episode. Nonetheless, according to European cardiologist association (2009 year) guidelines vasovagal syncope has benign prognosis, our analysis demonstrate that in 16,0±3,1 % of cases vasovagal syncope occurs during swimming, bicycle ride, road crossing, standing near open sewer manhole, that means, in this cases vasovagal syncope may lead to life threatening conditions. In depend of cardiovascular pathology type clinical presentation of syncope have special features. Syncope associated with structural heart pathology has an abrupt onset or associated with physical exercise, without any prodromal period. For patients with arrhythmia common causes of syncope are physical exercise and sudden stressful situations, prodromal period is also unusual. Characteristic features of vasovagal syncope are: presence of initiating agents (suffocating atmosphere, rapid body position change, heat, injections etc.), prodromal period characterized by vertigo, loss of vision, ear noise, sense of suffocation, sweating etc., and association with psychovegetative syndrome.

Keywords

• cardiovascular syncope
• children
• clinical characteristics