Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient

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Presentation transcript:

Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient Shubhayan Sanatani, MD, FRCPC, Vann Chau, MD, FRCPC, Anne Fournier, MD, FRCPC, Andrew Dixon, MD, FRCPC, Renée Blondin, MD, Robert S. Sheldon, MD, FRCPC Canadian Journal of Cardiology Volume 33, Issue 2, Pages 189-198 (February 2017) DOI: 10.1016/j.cjca.2016.09.006 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. Canadian Journal of Cardiology 2017 33, 189-198DOI: (10.1016/j.cjca.2016.09.006) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. Canadian Journal of Cardiology 2017 33, 189-198DOI: (10.1016/j.cjca.2016.09.006) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green light” indicates normal variants with no further management needed. AV, atrioventricular; bpm, beats per minute; ECG, electrocardiogram; PVC, premature ventricular complexes. ∗Manual measurement using tangent; see Figure 4. Canadian Journal of Cardiology 2017 33, 189-198DOI: (10.1016/j.cjca.2016.09.006) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 4 Measuring the QT interval. QTc is the heart rate corrected using the Bazett formula with use of the preceding RR interval. To determine QT, a tangent is drawn to the steepest slope of the last limb of the T wave in lead II or V5. The end of the T wave is the intersection of the tangent with the baseline. Modified from Postema et al.24 with permission from Elsevier. Canadian Journal of Cardiology 2017 33, 189-198DOI: (10.1016/j.cjca.2016.09.006) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions