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Syncope and Presyncope

Syncope or presyncope is a common symptom in teenagers, with 15% of adolescents having fainted at least once.

The single commonest cause is vasovagal or neural mediated syncope. It is however important to identify the 5% who have a cardiac mechanism for syncope e.g. prolonged QT syndrome, coronary artery anomaly or an outflow tract obstruction as there is a small but definite risk of SUDDEN DEATH

The following are RED FLAGS for referral
  • Syncope on or immediately following exertion
  • Previous cardiac surgery
  • Postural tachycardia or hypotension
  • Absence of presyncopal warning symptoms usually recounted in a "usual" faint e.g. weakness, light-headedness, nausea, visual blurring, feeling hot or cold and headaches
  • Palpitations preceding syncope
  • Age of onset < 10 years
  • Recurrent neural mediated syncope not responding to simple measures

Whilst the common neurally mediated form of syncope is not associated with sudden death there is considerable morbidity associated with recurrences including injury and functional impairments arising from a ‘restrictive lifestyle’. There are a number of specific and targeted therapies that can assist this group to lead a normal life.

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