Cardiac causes of syncope in the adolescent.

The optimal approach to the adolescent with syncope relies on a good working knowledge of its varied etiology; specifically, knowledge of the most common and generally benign type, vasovagal syncope, as well as the important distinguishing characteristics of the more serious and life threatening forms of cardiac syncope. A thorough history and physical examination are the cornerstones of investigation and will suggest the diagnosis in the vast majority of cases. Screening electrocardiography complements the history and physical, and is important in ruling out symptomatic arrhythmias impossible to diagnose by history and physical alone. Extensive invasive testing is usually unnecessary. Vasovagal syncope generally responds to reassurance and avoidance of precipitating triggers and positional changes. Beta blocker therapy is usually the first line of pharmacologic therapy. Treatment for other forms of syncope should be directed at the suspected underlying cause.