Clinical Audit on Evaluation of Patient With Syncope at Asssiut University Children Hospital
Clinical Audit on Evaluation of Patient With Syncope at Asssiut University Children Hospital
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)
Inclusion Criteria:

 -  all cases of syncope.

 Exclusion Criteria:

 -