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Synkopen im Kindes- und Jugendalter

Diagnose, Differenzialdiagnose und Therapie

Syncope in children and adolescents

Diagnosis, differential diagnosis and therapy

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Zusammenfassung

Synkopen im Kindes- und Jugendalter sind häufig und können zu erheblichem Leidensdruck führen. Meist handelt es sich um benigne Regulationsstörungen der Herzfrequenz und des Blutdrucks durch das autonome Nervensystem. Man kann Reflexsynkopen und Störungen der orthostatischen Regulation unterscheiden. Selten liegen potenziell lebensbedrohliche Ursachen zugrunde. Nichtkardiale Ursachen von Bewusstseinsstörungen aufgrund neurologischer, metabolischer oder endokrinologischer Störungen müssen abgegrenzt werden. Die Anamnese ist meist der Schlüssel zum Verständnis der Genese der Synkope und bestimmt die weitere Diagnostik. Therapeutisch reicht bei Kreislaufregulationsstörungen meist ein aufklärendes Gespräch mit Unterweisung in der Durchführung von Allgemeinmaßnahmen aus. Selten ist eine medikamentöse Therapie erforderlich. Eine Schrittmacherimplantation ist bei neurokardiogenen Synkopen mit prolongierter Asystolie in Ausnahmefällen indiziert.

Abstract

Syncope in childhood and adolescents is quite a common problem and patients and families are often scared by the event. The major cause of syncope is autonomous dysregulation of heart rate and blood pressure resulting in reflex syncope or orthostatic syncope, respectively. In a minority of patients potentially life-threatening causes of syncope, e.g. structural heart disease, cardiomyopathy and arrhyhmia are causative. Non-cardiac causes of unconsciousness due to neurological, metabolic or endocrine disease have to be differentiated. The clinical history is essential in understanding the cause of syncope and determines further diagnostic approaches. For autonomous dysregulation a consultation about the harmless nature of the event and general treatment strategies are often sufficient and medication is rarely necessary. Pacing because of prolonged asystole due to neurocardiogenic syncope is an exception.

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Authors and Affiliations

  1. Abteilung Kinderkardiologie und Pneumologie, Universitäts-Kinderklinik Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    B.C. Donner & K.G. Schmidt

  2. Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, München, Deutschland

    G. Hessling

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  1. B.C. Donner
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  2. G. Hessling
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  3. K.G. Schmidt
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Correspondence to B.C. Donner.

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Donner, B., Hessling, G. & Schmidt, K. Synkopen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 160, 499–514 (2012). https://doi.org/10.1007/s00112-012-2651-3

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