Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope

Christina Y. Miyake, Kara S. Motonaga, Megan E. Fischer-Colbrie, Liyuan Chen, Debra G. Hanisch, Raymond Balise, Jeffrey J. Kim, Anne M. Dubin

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design: We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. Results: A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Conclusions: Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

Original languageEnglish (US)
JournalCardiology in the Young
DOIs
StateAccepted/In press - Aug 17 2015
Externally publishedYes

Fingerprint

Syncope
Heart Diseases
Exercise Test
Pediatrics
Physical Exertion
Long QT Syndrome
Unconsciousness
Electrophysiology
Muscular Diseases
Electrocardiography
Exercise
Incidence

Keywords

  • children
  • diagnosis
  • exercise
  • exertion
  • paediatric
  • Syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope. / Miyake, Christina Y.; Motonaga, Kara S.; Fischer-Colbrie, Megan E.; Chen, Liyuan; Hanisch, Debra G.; Balise, Raymond; Kim, Jeffrey J.; Dubin, Anne M.

In: Cardiology in the Young, 17.08.2015.

Research output: Contribution to journalArticle

Miyake, Christina Y. ; Motonaga, Kara S. ; Fischer-Colbrie, Megan E. ; Chen, Liyuan ; Hanisch, Debra G. ; Balise, Raymond ; Kim, Jeffrey J. ; Dubin, Anne M. / Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope. In: Cardiology in the Young. 2015.
@article{89b4776e98bd4d63a67a7d6db04b1967,
title = "Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope",
abstract = "Objective: This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design: We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. Results: A total of 60 patients met the criteria for mid-exertional syncope; 32 (53{\%}) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Conclusions: Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.",
keywords = "children, diagnosis, exercise, exertion, paediatric, Syncope",
author = "Miyake, {Christina Y.} and Motonaga, {Kara S.} and Fischer-Colbrie, {Megan E.} and Liyuan Chen and Hanisch, {Debra G.} and Raymond Balise and Kim, {Jeffrey J.} and Dubin, {Anne M.}",
year = "2015",
month = "8",
day = "17",
doi = "10.1017/S1047951115001481",
language = "English (US)",
journal = "Cardiology in the Young",
issn = "1047-9511",
publisher = "Cambridge University Press",

}

TY - JOUR

T1 - Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope

AU - Miyake, Christina Y.

AU - Motonaga, Kara S.

AU - Fischer-Colbrie, Megan E.

AU - Chen, Liyuan

AU - Hanisch, Debra G.

AU - Balise, Raymond

AU - Kim, Jeffrey J.

AU - Dubin, Anne M.

PY - 2015/8/17

Y1 - 2015/8/17

N2 - Objective: This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design: We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. Results: A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Conclusions: Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

AB - Objective: This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design: We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. Results: A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Conclusions: Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

KW - children

KW - diagnosis

KW - exercise

KW - exertion

KW - paediatric

KW - Syncope

UR - http://www.scopus.com/inward/record.url?scp=84939449135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939449135&partnerID=8YFLogxK

U2 - 10.1017/S1047951115001481

DO - 10.1017/S1047951115001481

M3 - Article

C2 - 26277987

AN - SCOPUS:84939449135

JO - Cardiology in the Young

JF - Cardiology in the Young

SN - 1047-9511

ER -