From the Guidelines
Acute syncope at rest in adolescent males is most commonly caused by cardiac conditions, including myocarditis, long QT syndrome, and hypertrophic cardiomyopathy, which can lead to life-threatening arrhythmias and sudden cardiac death. According to the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, various conditions can cause syncope, including:
- Infectious causes, such as myocarditis, which can lead to ventricular tachycardia and atrioventricular block 1
- Neuromuscular causes, such as myotonic dystrophy and Friedreich ataxia, which can cause bradycardia and tachycardia 1
- Anatomic causes, such as anomalous coronary artery and aortic dissection, which can lead to obstruction of blood flow and hypotension 1
- Neurological disorders, such as seizure-induced bradycardia and hypotension, which can cause syncope 1 It is essential to note that while vasovagal syncope is a common cause of syncope in adolescents, cardiac causes are more concerning and can be life-threatening. Therefore, any adolescent male experiencing syncope should receive prompt medical evaluation, including a detailed history, physical examination, and possibly an ECG, to rule out cardiac causes. The management of syncope should be tailored to the underlying cause, and patients with cardiac causes may require urgent medical attention and treatment to prevent further complications.
From the Research
Common Causes of Acute Syncope
The common causes of acute syncope (fainting) at rest in adolescent males include:
- Neural causes
- Cardiovascular causes
- Non-cardiovascular causes 2 These causes can lead to transient global hypoperfusion of the brain, resulting in a sudden loss of consciousness and postural tone.
Benign Causes
In many cases, syncope in adolescent males is due to a benign neurocardiogenic (vasovagal) etiology, which is characterized by a disturbance of the normal autonomic nervous system reflexive mechanisms in regulating peripheral vascular resistance, blood pressure, and heart rate 3, 4. This type of syncope is often preceded by a prodrome of dizziness, nausea, diaphoresis, and pallor.
Life-Threatening Causes
However, syncope can also be a symptom of an underlying life-threatening cardiac or non-cardiac disorder, such as hypertrophic cardiomyopathy or long QT syndrome 3, 5. It is essential to evaluate the patient with syncope to determine whether they are at increased risk for death and need further evaluation or admission to the hospital.
Evaluation and Management
Evaluation of syncope should be based on a complete personal and family history, a thorough physical examination, and an electrocardiogram 3, 4. Patients with risk factors, such as recurrent syncope, exercise-induced syncope, or accompanying anginal chest pain, should be referred to a pediatric cardiologist for specialized testing and management 3. In cases of benign syncope, patient reassurance and education should be the first-line treatment 4.