Senkop

Yazarlar

Serap Uysal
https://orcid.org/0000-0002-9111-2889

Özet

Senkop, beyne giden kan ve oksijenin geçici olarak azalmasıyla ortaya çıkan, genellikle kısa süreli ve kendiliğinden iyileşen bir bilinç kaybı durumudur. Çocuklarda en yaygın nedeni vazovagal senkop olup, bu durum otonom sinir sisteminin yeterli kan basıncını koruyamaması sonucu gelişir ve çoğunlukla iyi huyludur. Kardiyojenik senkop gibi ciddi risk faktörleri dışlandığında, detaylı öykü ve klinik değerlendirme tanının temelini oluşturur. Tedavi yaklaşımı, altta yatan nedene göre belirlenmekte olup yaşam tarzı düzenlemeleri, hidrasyon ve gerekli durumlarda farmakolojik yöntemleri kapsamaktadır.

 

Syncope is a transient, self-limiting loss of consciousness characterized by a sudden reduction in global cerebral hypoperfusion. Vasovagal syncope is the most common cause in children, typically arising when the autonomic nervous system fails to maintain adequate blood pressure, and is generally benign. Once serious cardiac etiologies are excluded, diagnosis relies primarily on a detailed medical history and careful clinical evaluation. Management strategies are tailored to the underlying cause, ranging from lifestyle modifications and hydration to pharmacological interventions when necessary.

Referanslar

Kanjwal K, Calkins H. Syncope in Children and Adolescents. Cardiol Clin. 2015 Aug;33(3):397-409.

Arzimanoglou A, Duchowny M. S, Epilepsy and Other Seizure Disorders. Arzimanoglou A, O’Hare A, Jhonston M, Ouvrier R.Edits. Aicardi’s Diseases of the Nervous System in Childhood 4th edition. London: Mac Keith Press; 2018. p 851-999

Welch-Horan T.B, Rohit P. Shenoi R.P, Syncope. Shaw K.N, Bachur R.G. Pediatric Emergency Medicine. 7th Edition. Philadelphia:Wolters Kluwer; 2015.p 1016-27

Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/ AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2017;70:e39-e110.

Driscoll DJ, Jacobsen SJ, Porter CJ, et al. Syncope in children and adolescents. J Am Coll Cardiol. 1997;29:1039–45.

Lewis DA, Dhala A. Syncope in the pediatric patient. The cardiologist’s perspective. Pediatr Clin North Am. 1999;46:205–19.

Stephenson JBP (1990) Fits and Faints. Clinics in Developmental Medicine no. 109. London: Mac Keith Press.

Brignole M, Alboni P, Benditt DG, et al, Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope—update 2004. Europace 2004; 6:467–537

Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013 Sep;163(3):896-901.e1-3.

Brignole M, Moya A, de Lange FJ, et al. ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883-1948.

Singhi P, Saini AG. Syncope in Pediatric Practice. Indian J Pediatr. 2018 Aug;85(8):636-640.

MacNeill EC, Vashist S. Approach to syncope and altered mental status. Pediatr Clin North Am. 2013 Oct;60(5):1083-106.

Kanjwal K, Kanjwal Y, Karabin B, et al. Psychogenic syncope? A cautionary note. Pacing Clin Electrophysiol 2009;32(7):862–5.

Li HX, Gao L, Yuan Y. Advance in the understanding of vasovagal syncope in children and adolescents. World J Pediatr. 2021 Feb;17(1):58-62.

Cannon B, Wackel P. Syncope. Pediatr Rev. 2016 Apr;37(4):159-67; quiz 168

von Alvensleben JC. Syncope and Palpitations: A Review. Pediatr Clin North Am. 2020 Oct;67(5):801-810.

Sutton R. Should we treat severe vasovagal syncope with a pacemaker? J Intern Med. 2017;281:554–61.

Kruit MC, Thijs RD, Ferrari MD, Launer LJ, van Buchem MA, van Dijk JG. Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls. Neurology. 2013;80:1958–65.

Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update Ying Liao1• Junbao Du1

Kong Q, Yang X, Cai Z, et al. Twentyfour-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope. Ir J Med Sci. 2019;188:1279–87.

Chan WL, Lu TM, Wang JJ, Jiau SS, Kong CW. Haemodynamic significance of heart rate in neurally mediated syncope. Clin Cardiol. 2004;27:635–40.

Bondanelli M, Alboni P, Margutti A, et al. Plasma galanin response to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Metabolism. 2003;52:315–21

Alboni P, Dinelli M, Gruppillo P, et al. Haemodynamic changes early in prodromal symptoms of vasovagal syncope. Europace. 2002;4:333–8.

Benditt DG, Ermis C, Padanilam B, Samniah N, Sakaguchi S. Catecholamine response during haemodynamically stable upright posture in individuals with and without tilt-table induced vasovagal syncope. Europace. 2003;5:65–70.

Bai W, Chen S, Tang CS, et al. Gut microbiota analysis and its significance in vasovagal syncope in children. Chin Med J (Engl). 2019;132:411–9.

Zhang Q, Zhu L, Wang C, et al. Value of history taking in children and adolescents with cardiac syncope. Cardiol Young. 2013;23:54–60.

Schimpf R, Veltmann C, Wolpert C, et al. Channelopathies: Brugada syndrome, long QT syndrome, short QT syndrome, and CPVT. Herz. 2009;34:281–8.

Zhang Q, Xu B, Du J. Update of Individualized Treatment Strategies for Postural Orthostatic Tachycardia Syndrome in Children. Front Neurol. 2020 Jun 11;11:525.

Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management Guozhen Chen1,2,3, Junbao Du1,4, Hongfang Jin 2020

Tanaka H, Fujita Y, Takenaka Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int. (2009) 51:169–79.

Zhang Q, Du J, Wang C, Du Z, Wang L, Tang C. The diagnostic protocol in children and adolescents with syncope-a multi-center prospective study. Acta Pediatr. (2009) 98:879–84.

Medow MS. Postural tachycardia syndrome from a pediatrics perspective. J Pediatr. (2011) 158:4–6.

Li J, Zhang Q, Hao H, Jin H, Du J. Clinical features and management of postural tachycardia syndrome in children: a single-center experience. Chin Med J (Engl). (2014) 127:3684–9.

Lin J, Han Z, Li X, et al. Risk factors for postural tachycardia syndrome in children and adolescents. PLoS ONE. (2014) 9:e113625.

Bruce BK, Harrison TE, Bee SM, et al. Improvement in functioning and psychological distress in adolescents with postural orthostatic tachycardia syndrome following interdisciplinary treatment. Clin Pediatr (Phila). (2016) 55:1300–4.

Gonzalez Corcia MC, de Asmundis C, Chierchia GB, Brugada P. Brugada syndrome in the paediatric population: a comprehensive approach to clinical manifestations, diagnosis, and management. Cardiol Young. 2016 Aug;26(6):1044-55.

El-Battrawy I, Roterberg G, Schlentrich K, et al. Clinical Profile and Long-Term Follow-Up of Children with Brugada Syndrome. Pediatr Cardiol. 2020 Feb;41(2):290-296.

Casado-Arroyo R, Berne P, Rao JY, et al. Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification. J Am Coll Cardiol. 2016 Aug 9;68(6):614-623.

Skinner JR, Chung SK, Nel CA, et al. Brugada syndrome masquerading as febrile seizures. Pediatrics 2007; 119: e1206–e1211

Joensen P. Prevalence, incidence, and classification of epilepsy in the Faroes. Acta Neurol Scand 1986;74:150–5.

Zaidi A, Clough P, Cooper P, et al. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol 2000;36:181–4.

Courtheix M et al (2016) Syncope unit in the paediatric population: a single-centre experience. Arch Cardiovasc Dis 109(3):199–206

Tannemaat MR, Thijs RD, van Dijk JG (2014) Managing psychogenic pseudosyncope: facts and experiences. Cardiol J 21(6):658–664

Villafane J, Miller JR, Glickstein J, et al. Loss of Consciousness in the Young Child. Pediatr Cardiol. 2021 Feb;42(2):234-254.

Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology 2006; 66: 1730–1.

Syed TU, Arozullah AM, Suciu GP, et al. Do observer and self-reports of ictal eye closure predict psychogenic nonepileptic seizures? Epilepsia 2008; 49: 898–904

van Dijk JG, Thijs RD, van Zwet E, et al. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes. Brain. 2014 Feb;137(Pt 2):576-85.

Colman N, Nahm K, van Dijk JG, Reitsma JB, Wieling W, Kaufmann H. Diagnostic value of history taking in reflex syncope [Review]. Clin Auton Res 2004; 14 (Suppl 1): 37–44.

Wieling W, Thijs RD, van Dijk N, Wilde AA, Benditt DG, van Dijk JG. Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 2009;132:2630–2642.

Jarjour IT, Jarjour LK. Low iron storage in children and adolescents with neurally mediated syncope. J Pediatr. 2008 Jul;153(1):40-4.

Jin L, Huang XM, Wang C, Wu L, Lin P. Changes of serum iron and serum ferritin in children with vasovagal syncope. Chin J Appl Clin Pediatr. 2013;28:987–8

Guven B, Oner T, Tavli V, Yilmazer MM, Demirpence S, Mese T. Low iron storage in children with tilt positive neurally mediated syncope. World J Pediatr. 2013;9:146–51.

Numan M, Alnajjar R, Lankford J, et al. Cardiac asystole during head up tilt (HUTT) in children and adolescents: is this benign physiology? Pediatr Cardiol. 2015;36:140–5.

Rossano J, Bloemers B, Sreeram N, et al. Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in young patients with syncope and palpitations. Pediatrics. 2003;112:e228–33.

Al Dhahri KN, Potts JE, Chiu CC, et al. Are implantable loop recorders useful in detecting arrhythmias in children with unexplained syncope? Pacing Clin Electrophysiol. 2009;32:1422–7.

Frangini PA, Cecchin F, Jordao L, et al. How revealing are insertable loop recorders in pediatrics? Pacing Clin Electrophysiol. 2008;31:338–43.

Babikar A, Hynes B, Ward N, et al. A retrospective study of the clinical experience of the implantable loop recorder in a paediatric setting. Int J Clin Pract. 2008; 62:1520–5.

Ergul Y, Tanidir IC, Ozyilmaz I, et al. Evaluation rhythm problems in unexplained syncope etiology with implantable loop recorder. Pediatr Int. 2015;57:359–66.

Miyake CY, Motonaga KS, Fischer-Colbrie ME, et al. Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of midexertional syncope. Cardiol Young. 2015:1–7.

GrubbBP, FriedmanR. Syncope in child and adolescent. In: Grubb BP, Olshansky B, editors. Syncope: mechanisms andmanagement. 2nd edition. Mulden (MA): Blackwell Press; 2005. p. 273–86.

Driscoll DJ, Jacobsen SJ, Porter CJ, et al. Syncope in children and adolescents. J Am Coll Cardiol 1997;29:1039–45.

Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015, 12: e41–e63.

Chu W, Wang C, Wu L, et al. Oral rehydration salts: an effective choice for the treatment of children with vasovagal syncope. Pediatr Cardiol. 2015;36:867–72.

Rowe PC, Calkins H, DeBusk K, et al. Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial. JAMA 2001;285:52–9.

Qingyou Z, Junbao D, Chaoshu T. The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope. J Pediatr. 2006;149:777–80.

Côté JM. Syncope in children and adolescents: Evaluation and treatment. Paediatr Child Health. 2001 Oct;6(8):549-51.

Chen L, Wang L, Sun J, Qin J, Tang C, Jin H, et al. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J. (2011) 75:927–31.

Gelecek

25 Ocak 2023

Lisans

Lisans