THÔNG TIN TÀI LIỆU
drug ingestion or cardiac manifestations of eating disorders or central nervous system trauma, but can also be seen in healthy adolescents Syncope is uncommon in patients with first- or second-degree heart block, but complete heart block can potentially lead to more serious symptoms The combination of history, physical examination, and ECG allows identification of a cardiac cause of syncope in a majority of affected children, with reported sensitivity as high as 96% Patients with clinical features or ECG findings suggestive of heart disease should be referred to a cardiologist TABLE 76.2 ECG FINDINGS IN IMPORTANT CARDIAC CAUSES OF PEDIATRIC SYNCOPE Cause ECG findings Long QT syndrome QTc >450 msec; morphology of QT segment and T wave may vary in different genetic subtypes Brugada syndrome Elevated ST segments in precordial leads V1 and V2 Coving seen in Type syndrome; right bundle branch block Wolff–Parkinson– Classic triad of delta wave, shortened PR interval, and White syndrome widened QRS complex There is a slurring in upstroke of R wave Secondary ST-segment–T-wave changes are directed opposite to the major delta wave and QRS complex changes Hypertrophic The most frequent abnormalities found are large amplitude obstructive QRS complexes and associated ST-segment and T-wave cardiomyopathy changes consistent with left ventricular hypertrophy (HOCM) Deep, narrow Q waves in leads II, III, aVF, V5, and V6 are most characteristic and specific findings of HOCM Left atrial enlargement is also seen Bradycardia Second- and third-degree heart block To summarize, risk factors for a cardiac etiology for syncope include the absence of prodromal symptoms, palpitations that occur seconds before loss of consciousness, lack of a prolonged upright posture, exertion-related syncope or syncope that occurs with auditory or emotional stimuli, a family history of sudden cardiac death, abnormal physical examination, and abnormal ECG Patients with
Ngày đăng: 22/10/2022, 12:32
Xem thêm: