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Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope

Published online by Cambridge University Press:  17 August 2015

Christina Y. Miyake ,
Kara S. Motonaga ,
Megan E. Fischer-Colbrie ,
Liyuan Chen ,
Debra G. Hanisch ,
Raymond R. Balise ,
Jeffrey J. Kim  and
Anne M. Dubin
Christina Y. Miyake*
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
Kara S. Motonaga
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
Megan E. Fischer-Colbrie
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
Liyuan Chen
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
Debra G. Hanisch
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
Raymond R. Balise
Affiliation:
Department of Health Research and Policy, Stanford University, Palo Alto, California, United States of America
Jeffrey J. Kim
Affiliation:
Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Anne M. Dubin
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, California, United States of America
*
Correspondence to: C. Y. Miyake, MD, MS, Department of Pediatrics, Texas Children’s Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America. Tel: +832 826 5650; Fax: +832 825 0327; E-mail: cymiyake@bcm.edu
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Abstract

Objective

This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes.

Study design

We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded.

Results

A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis.

Conclusions

Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

Keywords

Syncopeexertionexercisechildrenpaediatricdiagnosis
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 894 - 900
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Copyright
© Cambridge University Press 2015 

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