Investigation of 24-hour blood pressure monitoring for evaluating treatment outcome of nerve-mediated syncope in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of 24-hour blood pressure monitoring (ABPM) for evaluating the treatment outcome of nerve-mediated syncope (NMS) in children.</p><p><b>METHODS</b>Twenty-eight children with NMS confirmed by a head-up tilt table test (HUTT) (12 males and 16 females, aged 6-13 years) and with a chief complaint of unexplained syncope or pre-syncope between February 2010 and August 2012, were included in the study. These children received health education combined with therapy using oral rehydration salts solution and were then reexamined for clinical symptoms as well as HUTT and ABPM results.</p><p><b>RESULTS</b>Of 28 NMS cases, 22 were vasodepressive type, 5 were mixed type, and 1 was cardioinhibitory type. The follow-up showed that 27 (96%) of all cases had improved clinical symptoms, and 18 (64%) had improved HUTT results. The ABPM follow-up revealed no significant changes in 24-hour mean systolic pressure, 24-hour mean diastolic pressure, daytime mean systolic pressure, daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, day-night difference of systolic pressure, and day-night difference of diastolic pressure after treatment (P>0.05). The percentage of children with a dipper blood pressure pattern increased from 29% (8/28) before treatment to 50% (14/28) after treatment; the percentage of children with a non-dipper blood pressure pattern decreased from 71% (20/28) before treatment to 50% (14/28) after treatment.</p><p><b>CONCLUSIONS</b>As an effective, objective and non-invasive monitoring means, ABPM is of some clinical significance for evaluating the treatment outcome of NMS in children.</p>

Clinical significance of changes in T wave and ST segment amplitudes on electrocardiogram from supine to standing position among children with unexplained chest tightness or pain in resting stage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of changes in T wave and ST segment amplitudes on electrocardiogram (ECG) from supine to standing position in children with unexplained chest tightness or pain in resting stage.</p><p><b>METHODS</b>A total of 122 6-14-year-old children with a chief complaint of unexplained chest tightness or pain (resting stage) underwent head-up tilt test (HUTT). According to HUTT results, these children were divided into HUTT-positive (n=61) and HUTT-negative groups (n=61). They underwent 12-lead ECG in the supine and standing positions, and heart rate and T wave and ST segment amplitudes in II, III, aVF and V5 leads were measured.</p><p><b>RESULTS</b>In the HUTT-negative group, heart rates were significantly higher in the standing position than in the supine position (P<0.05), T wave amplitudes in II, III, aVF, and V5 leads were significantly lower in the standing position than in the supine position (P<0.05), and ST segment amplitudes in II, aVF and V5 leads were significantly higher in the standing position than in the supine position (P<0.05). In the HUTT-positive group, heart rates were significantly higher in the standing position than in the supine position (P<0.05), T wave amplitudes in II, III, aVF and V5 leads were significantly lower in the standing position than in the supine position (P<0.05), and ST segment amplitude in V5 lead was significantly higher in the standing position than in the supine position (P<0.05). There were no significant differences between the two groups with respect to ST segment amplitude and T wave amplitude in II, III and aVF leads of the supine or standing position (P>0.05). Compared with the HUTT-negative group, the HUTT-positive group had significantly greater T wave amplitude differences in II, III, aVF and V5 leads, and heart rate difference from supine to standing position (P<0.05).</p><p><b>CONCLUSIONS</b>Among the children with unexplained chest tightness or pain in resting stage, T wave amplitude differences in II, III, aVF and V5 leads and heart rate difference from supine to standing position are greater in the HUTT-positive group than in the HUTT-negative group. This suggests that the changes in T wave amplitude on ECG from supine to standing position can indicate autonomic nervous system dysfunction.</p>

Causes of unexplained syncope in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the common causes of unexplained syncope in children.</p><p><b>METHODS</b>A total of 434 children with unexplained syncope who were aged from 3.0 to 17.9 years (192 males and 242 females) and who saw the doctor between January 2006 and October 2011. were examined in order to explore the detailed histories and causes of syncope and to analyze variance in causes among different ages, genders, syncope frequencies and head-up tilt test (HUTT) results.</p><p><b>RESULTS</b>(1) The causes of occasional syncope included persistent standing (30%), movement (13%), change in body position(9%), sitting(7%), and playing(6%). Persistent standing was more common as a cause in females than in males (P<0.01). Micturition syncope was mainly seen in males. Sultry weather was the main cause of syncope in females. Change in body position was a more common cause in the ≥12 years group than in the <12 years group (P<0.05), while other causes showed no significant differences among different age groups. Change in body position was a more common cause of syncope in children with negative HUTT results than in those with positive HUTT results (P<0.05). (2) All causes of occasional syncope can induce repeated syncope, and most repeated syncope (56%) had the same cause.</p><p><b>CONCLUSIONS</b>The common causes of unexplained syncope include persistent standing, movement and changes of body position in children. Avoiding these causes is helpful for prevention of childhood syncope.</p>

Diagnosis of vasovagal syncope in children with postural orthostatic tachycardia syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the diagnosis of vasovagal syncope (VVS) in children with postural orthostatic tachycardia syndrome (POTS).</p><p><b>METHODS</b>The clinical data of 57 children with POTS diagnosed by the head-up tilt test between January 2007 and December 2010 were studied retrospectively. Of the 57 children, there were 29 boys and 28 girls who were aged from 5 to 16 years (12.2±1.9 years).</p><p><b>RESULTS</b>Twenty-four (42%) out of 57 children were diagnosed with VVS by prolonging the duration of the head-up tilt test (for the children with orthostatic tolerance): cardioinhibitory (20 cases), mixed (3 cases) and vasoinhibitory (1 case). The POTS children with VVS were older than those without (13.0±1.4 years vs 11.5±2.1 years; P<0.05). There were no significant differences in gender and clinical symptoms between the POTS children with and without VVS.</p><p><b>CONCLUSIONS</b>Some children with POTS may have coexisting VVS, suggesting that it is important to avoid misdiagnosis of VVS by prolonging the duration of head-up tilt test in POTS children with orthostatic tolerance. There are no obvious differences in gender and clinical symptoms between the POTS children with and without VVS.</p>