Syncope in children and adolescents as a sudden, transient, short-term and spontaneously reversible loss of consciousness caused by a decrease in cerebral perfusion

1 Department of Paediatric Cardiology, Upper Silesian Child Health Centre in Katowice, Poland. Head of the Department: Professor Lesław Szydłowski, MD, PhD
2 Teaching and Research Department of Paediatric Cardiosurgery and Intensive Therapy, Polish-American Institute of Paediatrics, Jagiellonian University Medical College, Cracow, Poland.
Head of the Department: Professor Janusz Skalski, MD, PhD
3 Teaching and Research Department of Paediatric Cardiology, Upper Silesian Child Health Centre in Katowice, Medical University of Silesia in Katowice, Poland.
Head of the Department: Professor Lesław Szydłowski, MD, PhD
Correspondence: Professor Lesław Szydłowski, MD, PhD, Clinic of Paediatric Cardiology, Silesian Child Health Center in Katowice, Medyków 16, 40-752 Katowice, Poland,
tel.: +48 32 207 18 55, fax: +48 32 207 18 54, e-mail: szydlowskil@interia.pl

 

Pediatr Med Rodz Vol 10 Numer 3, p. 234–241
DOI: 10.15557/PiMR.2014.0026
ABSTRACT

Syncope is a common symptom in adolescents who come to the hospital emergency wards. The most common form of syncope is neurogenic type caused by impaired autoregulation of the circulatory system. This syncope is not generally life-threatening condition in a contrast to the less common but most dangerous cardiogenic type (e.g. cardiac arrhythmias due to Wolff–Parkinson– White syndrome, long QT time interval, atrioventricular blocks, haemodynamic obstructions in the outflow tract of the left or right ventricle, cardiomyopathy or coronary abnormalities). This paper refers to a new term, i.e. transient loss of consciousness. According to the new definition of syncope from 2009, temporary loss of consciousness has four components: a sudden occurrence, transient nature, short duration, and spontaneous regression. Currently, there are three main types of syncope associated with the cardiovascular system: neurogenic, orthostatic hypotension and a cardiac. The most common form in adolescents are neurogenic fainting which are often preceded by prodromal symptoms, i.e. decrease in blood pressure and heart rate. They can also occur in response to the stress or unusual situations. In the orthostatic syncope the loss of consciousness occurs in a very short time after the upright position and unlike neurogenic form, usually there are no prodromal symptoms, but tachycardia is present. The rarest, but also the most dangerous form of syncope is a cardiogenic type caused by arrhythmias or structural heart disease. This form may be the first sign of serious heart disease or even precede sudden cardiac death.

Keywords: syncope, presyncope, transient loss of consciousness (T-LOC), postural orthostatic tachycardia syndrome (POTS)