⚡ Syncope · Neurocardiogenic (Vasovagal) · Cardiac (Long QT, HCM) · Seizure · Orthostatic

Schwartz Clinical Handbook — Chapter 74 · Triggers (prolonged standing, heat, emotion) · ECG (QTc, delta wave) · Murmur (HCM, AS) · Family history sudden death

Select triggers (standing, heat, exercise), prodrome (dizziness, nausea, pallor), palpitations, seizure activity, family history of sudden death, and ECG findings → differentiate neurocardiogenic (vasovagal) syncope (most common) from cardiac (long QT, HCM, WPW, aortic stenosis) and neurologic (seizure) causes.
⚠️ Red flags: syncope during exercise, with palpitations, family history of sudden death, abnormal ECG → cardiology referral, echocardiogram, Holter/event monitor.

📋 Step 1 — Triggers, prodrome & family history
📌 Diagnostic impressions
📖 Schwartz Ch 74

Select triggers (prolonged standing, heat, emotion, exercise), prodrome (lightheadedness, nausea, pallor), palpitations, seizure activity (tonic‑clonic, incontinence), family history of sudden death, and ECG findings (QTc, delta wave, LVH) → differentiate neurocardiogenic syncope (benign, most common) from cardiac syncope (long QT, HCM, WPW, aortic stenosis) and seizure.

✔️ Neurocardiogenic: prodrome (dizziness, nausea), trigger (standing/heat), brief LOC, no cardiac history.
✔️ Cardiac syncope: during exercise, palpitations, family sudden death, abnormal ECG.
✔️ Long QT: prolonged QTc, Torsades, syncope with exercise/startle.
✔️ HCM: murmur, LVH, family HCM, syncope during exertion.
✔️ Seizure: postictal confusion, tongue biting, incontinence.
📘 Schwartz pearls (Chapter 74)
• ECG mandatory for every child with syncope (QTc, WPW, LVH).
• Neurocardiogenic: reassurance, increased fluid/salt intake.
• Long QT: avoid QT‑prolonging drugs, beta‑blockers, ICD if high‑risk.
• HCM: avoid strenuous exercise, beta‑blockers, ICD.
• Tilt‑table test for refractory vasovagal syncope.