Evaluation of commitment of resident physician to the guidelines as regard management of cases of syncope at Assiut University Children Hospital and correction of the defect that will be discovered.
Definition Syncope is a transient loss of consciousness associated with inability to maintain postural tone followed by rapid and spontaneous recovery. (1) Epidemiology About 30-50% of children have syncope at least once in their lives till adolescent period, most of them are girls, 9% is the rate of syncope in 15-17 years old adolescent group, and this rate increase to the end of adolescent period. (2) Causes (3) I\_Neurally mediated syncope 1. Neurocardiogenic (vasovagal) * Emotional stress induced (pain, fear, blood phobia, etc.) * Orthostatic stress induced 2. Situational syncope * Respiratory (cough, sneeze, laugh, head turning) * Gastrointestinal stimulation (swallowing, defecation, postprandial) * Post micturition * Post exercise * Others 3. Carotid sinus syncope 4. Glossopharyngeal and trigeminal neuralgia syncope II\_Cardiogenic syncope * Arrhythmias as Bradycardia: - sinus node dysfunction (including bradycardia/tachycardia syndrome) - atrioventricular conduction system disease Tachycardia: - supraventricular - ventricular * Structural heart defects as acute myocardial infarction/ischaemia, hypertrophic cardiomyopathy, cardiac masses (atrial myxoma, tumours, etc.), pericardial disease /tamponade. * Functional heart defects as prosthetic valve dysfunction, pulmonary hypertension. * Vascular heart abnormalities as aortic stenosis, congenital anomalies of coronary arteries, pulmonary embolus, acute aortic dissection. III\_ Orthostatic hypotensive syncope * Primary autonomic disorder * Secondary autonomic disorder * Drug-induced orthostatic hypotension * Hypovolemia related IV\_Postural orthostatic tachycardia syndrome V\_Metabolic reasons of syncope * Hypoglycemia * Hypoxia * Electrolyte imbalance VI\_Psychogenic syncope * Anxiety * Panic attack * Depression * Somatization VII\_Drug-induced syncope * Antihypertensives, diuretics, barbiturates, tricyclic antidepressants, alcohol, antiarrhythmics, macrolides, antihistamines, antipsychotics, MAO inhibitors, levodopa, prazosin, benzodiazepines VIII\_Airway obstruction induced syncope IX\_Hyperventilation-induced syncope X\_Neurologic Syncope * Cerebrovascular diseases * Increased intracranial pressure * Migraine Symptoms * The prodrome is the most important aspect of the history. * A warm or clammy sensation, nausea, light headedness or visual changes (e.g seeing spots, grey out, tunneling)are strongly suggestive of vasovagal syndrome, other symptoms include irritability, confusion, auditory changes or dyspnea. * The absence of prodrome raise the suspicion of a possible cardiac cause. 85%of children with vasovagal syncope has a prodrome, wheras only 40% of those with cardiac condition had a prodromal symptoms. Palpitation and chest pain have been related to pediatric cardiac cause of syncope.(4) vasovagal syncope might also produce complex movement which raise a suspicion of epilepsy.(5) * Most syncope is vasovagal, which is benign and doesn't require extensive investigation. The position statement presents recommendation to encourage an efficient and cost effective deposition for the many patients with a benign cause of syncope and hightlight atypical or concerning clinical findings associated with other causes of transient loss of consciousness. * The prodrome and cirumstances around which the event occurred are the most important aspect of the history. * Syncope occurring midexertion suggest cardiac etiology. A family history includes sudden death in the young or from unknown causes or causes that might be suspected to be other than natural can be a red flag. * ECG is the most frequently ordered test, but the yield is low, It's recommended when patient's history isn't suggestive of vasovagal syncope and other features suggestive of cardiac cause like absence of prodrome, midexertion and family history of early life sudden death or heart diseases, abnormal physical examination or a new medication with potential cardiac cardiotoxicity.(6)
Study Type
OBSERVATIONAL
Enrollment
30
Clinical audit on evaluation of a child with syncope at Assiut University children Hospital
Evaluation of commitment of resident physician to the guidelines as regard management of cases of syncope at Assiut University Children Hospital
Time frame: Baseline
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