Congenital Lesions That Produce Syncope

A child's sudden loss of consciousness is usually due to a previously unrecognized seizure and seldom due to dysrhythmia. When syncope does occur, children are often brought to the emergency department for initial evaluation. An accurate history from a reliable witness is essential to establish cardiac causes as the exact etiology. Typically, the history describes a child who has an initial change in skin color with or without cyanosis, a controlled fall, and then loss of consciousness.

The differential diagnosis includes tetralogy of Fallot, critical aortic stenosis, sick sinus syndrome, hypertrophic cardiomyopathy, and prolonged QT syndrome. Each are discussed in detail next.

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