Differential Diagnosis for a 6-year-old boy with congenital deafness and fainting episode
- Single most likely diagnosis:
- Long QT Syndrome (LQTS): The patient's history of congenital deafness, fainting episode during physical activity, and family history of sudden death during a swim meet are highly suggestive of LQTS, particularly the Jervell and Lange-Nielsen syndrome, which is associated with congenital deafness.
- Other Likely diagnoses:
- Vasovagal syncope: Although the patient's episode was not typical for vasovagal syncope (e.g., no prodrome, no prolonged recovery), it is still a possible cause of fainting in children.
- Cardiac channelopathies (e.g., Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia): These conditions can cause syncope and sudden cardiac death, especially during physical activity.
- Do Not Miss diagnoses:
- Hypertrophic cardiomyopathy: Although the cardiac examination is normal, hypertrophic cardiomyopathy can cause sudden cardiac death, especially during physical activity, and should not be missed.
- Arrhythmogenic right ventricular cardiomyopathy: This condition can also cause sudden cardiac death and should be considered, especially with a family history of sudden death.
- Rare diagnoses:
- Commotio cordis: A rare cause of sudden cardiac death due to a blunt trauma to the chest, which can cause a fatal arrhythmia.
- Wolff-Parkinson-White syndrome: A rare condition that can cause supraventricular tachycardia and syncope, although it is less likely given the patient's ECG results.
The most appropriate pharmacologic treatment for this patient would likely be D. Propranolol or F. Sotalol, as both are commonly used to treat Long QT Syndrome. However, the final answer would depend on the specific diagnosis and the patient's response to treatment.