Syncope

• Transient loss of consciousness and muscle tone with 
spontaneous recovery 

• Incidence 126/100.000 and 15% before 18 yrs

experience an episode

• 0.4 – 1% E.R. admission and 3‐4% of cardiologist call

• How often related to the heart? 

• Children’s mostly benign/non cardiac
 Vasovagal-Neurocardiogenic or Common Syncope

• 70% of cases

• Peak 16‐19 yrs

• Females >>>males

Sudden reduction of BP and sometime HR

Reduction of brain perfusion

Loss of consciousness
 Vasovagal-Neurocardiogenic or Common Syncope

• Normal cardiovascular reflex: 

• Standing posture  blood to the lower extremities
• Decrease venous return, stroke volume, BP
• Less stretching of vent muscle and mechanoreceptors
• Decreased arterial pressure, increase sympathetic output with 
Higher HR, vasoconstriction (higher diastolic pressure)

• Inverted cardiovascular reflex:

• Activation of LV mechanoreceptors (normally only responds to 
stretch) mimicking high BP condition 
• Paradoxical withdrawal of sympathetic activity, vasodilatation, 
hypotension and bradycardia and reduction of brain perfusion 
 Vasovagal-Neurocardiogenic or Common Syncope
CAUSES
• Anxiety
• Fear
• Pain
• Blood 
• Fasting
• Hot and humid conditions
• Crowded places
• Prolonged motionless standing

D.D.
Neuropsychiatric events
MIgraine, Epilepsy, Depression, hysteria
Metabolic
Drugs, dyselettrolitemia, endocrine disease, hypoglycemia
 Vasovagal-Neurocardiogenic or Common Syncope
DIAGNOSIS

• HISTORY

• CLINICAL EXAMINATION

• EKG and CARDIOLOGIST CONSULTATION

• METABOLIC WORKUP

• NEUROPSYCHIATRIC EVALUATION
 Cardiac causes of Syncope

Structural heart disease
Ebstein
Myocarditis
Arrhythmia
SVT
VT
CHB
LONG QT
WPW