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Synkopen bei Kindern und Jugendlichen

Schwerpunkt
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Zusammenfassung

Synkopen sind im Kindesalter häufig. Affektkrämpfe, vasovagale Synkopen, neurogene und neurokardiogene Synkopen basieren auf einem gemeinsamen Pathomechanismus und werden unter dem Begriff neurogene Synkopen zusammengefasst. Neurogene Synkopen liegen bei ca. 75 % der Synkopen im Kindesalter vor. Eine kardiale Synkope besteht in bis zu 6 % der Fälle. Die Differenzierung zwischen einer benignen Ursache und einer unter Umständen lebensbedrohlichen Ursache der Synkope gelingt in der überwiegenden Zahl der Kinder und Jugendlichen mittels detaillierter Anamnese, körperlicher Untersuchung und anhand des Ruhe-EKG. Eine Kipptischuntersuchung kann bei ungeklärter Ursache im Einzelfall zur Diagnose führen. Bei Kindern mit neurogenen Synkopen ist häufig durch eine Änderung des Lebensstils, Vermeidung der auslösenden Situationen sowie Beruhigung der Familie Symptomfreiheit zu erzielen. Bei fehlendem Effekt kann eine sympathomimetische medikamentöse Therapie mit Midodrin effektiv sein. Fludrocortison und eine antibradykarde Stimulation sind bei ausgewählten Patienten hilfreich. Eine β‑Blocker-Therapie ist nicht von Nutzen. Kardiale Ursachen sind krankheitsspezifisch zu behandeln.

Schlüsselwörter

Neurogene Synkope Bewusstseinsverlust Kurzzeitige globale zerebrale Hypoperfusion Pathomechanismus Midodrin 

Syncope in children and adolescents

Abstract

Syncope is common in children and adolescents. Neurally mediated syncope including pallid and cyanotic breath holding spells, vagovasal syncope and neurocardiogenic syncope is based on a common pathomechanism and accounts for approximately 75% of cases. A potentially life-threatening cardiac cause of syncope may be present in up to 6%. Detailed history, physical examination and 12-lead electrocardiogram (ECG) allow discrimination between benign and serious syncope in the majority of pediatric patients. Tilt-testing can be useful when diagnosis is unclear. In neurally mediated syncope, education on awareness of prodromes, modification of life-style and reassurance of the family on benign character of the disease is sufficient for preventing further syncopal episodes in the majority of cases. In pediatric patients unresponsive to these measures midodrine is often effective. Fludrocortisone and cardiac pacing may be considered in selected patients. β‑Blockers are not beneficial in pediatric neurally mediated syncope. Cardiac causes need specific disease-targeted therapy.

Keywords

Neurally mediated syncope Loss of consciousness Short-term global cerebral hypoperfusion Pathomechanisms Midodrine 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M.J. Müller und T. Paul geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Pädiatrische Kardiologie und IntensivmedizinUniversitätsklinikum GöttingenGöttingenDeutschland

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