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Common disorders that frequently present as a result of functional issues in the pediatric emergency department include chronic non-pathological pain, acute chest pain, syncope, recurrent abdominal pain, and fatigue. These complaints are often broad in nature and nonspecific, leading to potentially lengthy diagnostic evaluations that are cumbersome for both the patient and the healthcare system. This chapter describes three cases of patients presenting to the emergency department whose optimal treatment required addressing their underlying psychological issues. Incorporation of child life specialists and others trained in non-pharmacologic stress reduction can assist in alleviating the anxiety and pain associated with functional issues in such patients. [ABSTRACT FROM AUTHOR]

Chest pain, syncope, and palpitations are the most common chief complaints in children that might be cardiac in origin. Although all three are often associated with significant heart disease in adults, they usually represent benign conditions in children, do not require aggressive treatment, and may be considered to some degree ˵functional.″ Nevertheless, parents of children with any of these complaints are often anxious that their child may be the exceptional case with life-threatening (usually cardiac) disease. The purpose of this chapter is to provide the primary care practitioner with a practical office approach to the child with chest pain, syncope, or palpitations of a semiacute or chronic nature. For each complaint the most common noncardiac, as well as the rarer cardiac causes will be reviewed. A discussion follows that emphasizes important aspects of the history and physical examination that will help to differentiate cardiac from less serious, noncardiac causes. The main objective is to help the practitioner to evaluate each complaint effectively, reassure patients and families appropriately, and avoid unnecessary testing and referrals to an emergency department or subspecialists. [ABSTRACT FROM AUTHOR]

Nonsustained ventricular tachycardia remains a common management problem in the medical community. Treatment is sometimes needed for the suppression of symptoms. More commonly, nonsustained ventricular tachycardia is asymptomatic and the clinician must determine the prognostic importance. The prognostic implications, the role of electrophysiologic study and other risk stratification strategies, and the potential role of pharmacologic and defibrillator intervention depend on the underlying cardiac substrate present in the individual patient. Currently available data regarding the entity are discussed in this chapter. [ABSTRACT FROM AUTHOR]

The electrophysiology study is central to the field of cardiac electrophysiology. This chapter begins by describing maneuvers performed in a basic electrophysiology study. Indications for an electrophysiology study are then discussed. They include (1) evaluation of syncope, (2) diagnosis of an arrhythmia, (3) evaluation of patients with Wolff–Parkinson–White, and (4) risk stratification of sudden cardiac death. The role of EP studies in non-ischemic cardiomyopathies is also addressed. [ABSTRACT FROM AUTHOR]

Over the past half century, LQTS has matriculated through several critical milestones including its sentinel clinical description, clinical diagnostic scorecard, pathogenetic discovery, decade of research-based genetic testing and genotype–phenotype correlations, and clinical availability of genetic testing. In this chapter, we will discuss the history, epidemiology, and clinical presentations of congenital long QT syndrome (LQTS). We will clarify current diagnostic approaches to LQTS, including clinical history and specific diagnostic testing. Treatment strategies including pharmacologic and surgical techniques will be examined, as well as the role of individualized treatment for the LQTS patient. Finally, preventative strategies will be discussed, including athletic participation. [ABSTRACT FROM AUTHOR]

Short QT Syndrome is a recently recognized inherited channelopathy responsible for sudden cardiac death (SCD) in individuals with a structurally normal heart. It is characterized by abnormally short QTc interval (<360 msec) on the electrocardiogram seen in conjunction with a family history of atrial and/or ventricular fibrillation. It is a genetically heterogeneous disease with mutations in five different genes encoding cardiac ion channels linked to familial or sporadic cases. Based on the chronology of discovery, gain-of-function mutations in KCNH2, KCNQ1, and KCNJ2 have been labeled SQT1, SQT2 and SQT3, respectively. In addition, loss-of-function mutations in two calcium channel genes CACNA1C and CACNB2B have been linked to a new clinical entity characterized by a SQTS and Brugada syndrome phenotype. These have been designated as SQT4 and SQT5, respectively. SCD is a common presenting symptom and has been reported as early as the first year of life, suggesting that SQTS may be responsible for some cases of sudden infant death. Amplified transmural dispersion of repolarization along with abbreviation of the refractory period is thought to underlie the cellular basis for arrhythmogenesis in SQTS. Implantation of an implantable cardioverter defibrillator is recommended for both primary and secondary prevention of SCD. Data regarding a pharmacologic approach to therapy are limited, but quinidine has been identified as being of benefit. This chapter provides an overview of the available literature. [ABSTRACT FROM AUTHOR]

Syncope is a syndrome characterized by a relatively sudden, temporary, and self-terminating loss of consciousness. Possible causes of syncope are numerous, but the unifying feature is the underlying pathophysiology; specifically, a temporary inadequacy of cerebral nutrient flow most often due to a fall in systemic arterial pressure. Delineating the underlying etiology of syncope in a given patient is often challenging but is important, since syncope, while even if often relatively benign from a mortality perspective, tends to recur. An inaccurate diagnosis and an incorrect treatment leave the affected individual at risk of physical injury, diminished quality-of-life, and possible restriction from employment or avocation; furthermore, a life-threatening problem may be missed (e.g., cardiac syncope, channelopathies). In the majority of patients presenting with syncope a careful history, physical examination, ECG, and possibly an echocardiogram are sufficient to establish the diagnosis with substantial certainty. The most common example is when the history is indicative of one of the neurally mediated reflex faints (i.e., vasovagal, carotid sinus, or situational syncope). However, although the medical history is the physician΄s most valuable tool in the initial syncope assessment, its value is undermined if it is inadequate in detail and/or the patient cannot provide a reliable description of events (e.g., children, patients with cognitive impairment). In these latter cases or if the initial evaluation is inconclusive, selective application of further diagnostic tests (e.g., ambulatory ECG monitoring, head-up tilt test) is needed. As a rule assessment should be lead by physicians who take a particular interest in the syncope evaluation. In this regard, more widespread development of syncope management units (SMUs) and rapid access syncope/falls clinics is strongly encouraged; together, they have been shown to reduce both hospital costs and number of undiagnosed cases. [ABSTRACT FROM AUTHOR]

The significant physiologic adaptations of pregnancy predispose to arrhythmias, while concurrent changes in pharmacokinetics and concerns for fetal health and well-being complicate management. An increased incidence of both atrial and ventricular arrhythmias has been reported in population-based Holter studies, yet most incident pregnancy-related arrhythmias are benign and do not require intervention. Pharmacologic absorption, distribution, metabolism, and elimination are altered, as are gut absorption, protein binding, and hepatic and renal blood flow. This chapter will review antiarrhythmic drug therapy by Vaughn Williams classification, nonpharmacologic arrhythmia therapy (cardiovascular implanted electronic devices and ablation), as well as management of specific cardiovascular conditions during pregnancy, labor, and postpartum. [ABSTRACT FROM AUTHOR]

An encyclopedia entry for "absence epilepsy" is presented. It offers clinical information on absence epilepsy, which refers to the prototype for the idiopathic generalized epilepsies (IGE). Absence seizure is characterized with an alteration in consciousness alone or with additional features. It is also described as having abrupt arrest of ongoing activities, stare, eye fluttering and brief impairment of consciousness.

Chapter 5 of the book "Clinical Adult Neurology," Third Edition, is presented. The chapter examines the basic pathological concepts involved with transient interruption of consciousness. Detailed in the chapter are the definitions of syncope and seizure. The difference between primary generalized seizures and partial seizures is explained.

Chapter 13 of the book "The Management of Medical Emergencies: A Guide for Dental Care Professionals," by Colette Balmer and Lesley Longman is presented. It discusses the definition, predisposing factors, signs and symptoms, and management of faint. Also called as syncope, it is a sudden loss of consciousness caused by temporary insufficient blood supply to the brain. When stress and anxiety associated with dental treatment causes a faint, the value of using sedation should be considered.

Chapter 8 of the first book of "The Coming Bill," by P. G. Wodehouse is presented. It relates the weariness felt by Kirk Winfield regarding the provision of extra care to his wife Ruth on her pregnancy. Furthermore, it highlights the assistance of Steve Dingle on the condition of Kirk from fainting at his own studio.

Part II chapter 6 of the book "The Captives," by Hugh Walpole is presented. It narrates Martin Warlock's decision to leave Maggie Cardinal for his own good and expressed his disapproval on the engagement of her sister, Amy with Mr. Thurston. It highlights how he uttered his grievances to his father and the sudden collapsed of the latter.

Part I chapter 4 of the book "The Captives," by Hugh Walpole is presented. It presents how Maggie Cardinal astonished with the silence, cleanliness and tidiness of her aunts' home in London, England. It highlights how Maggie fainted while talking with her aunts' friend and while they were listening a clergy sermon in a chapel.

Chapter XXXIII of the book "Barriers Burned Away," by E. P. Roe is presented. It depicts the pride in the heart of Christine Ludolph and resoluteness to paint Dennis Fleet's bitterness. It depicts the fainting of Dennis as a result of the painful discovery of Christine's pretenses. It highlights the regret felt by Christine after examining Dennis' art works.

An encyclopedia entry for "syncope" is presented. It refers to a sudden brief loss of consciousness caused by a relative ischemia to the brain due to a decrease in cerebral blood flow. It accounts for 3 percent of emergency department (ED) visitations in the U.S. It notes that syncope is similar to seizure.

An encyclopedia entry for "convulsive syncope" is presented. It relates the distinction of syncope from seizure. It outlines the distinguishing characteristics of prolonged syncope such as triggers by known precipitants such as cough, pain, or emotional triggers such as during phlebotomy, hot environments, exercise, or micturition or defecation. Convulsive syncope is characterized by rapid, brief and often asymmetric limb flexion that appears concurrently, shortly after the fall to the ground.

An encyclopedia entry for "breath-holding spells" is presented. These refer to nonepileptic paroxysmal events that occur in approximately 4% of children younger than 5 years of age. Such episodes present as cyanotic syncope caused by fear, pain, surprise, anger or frustration. Symptoms may also include atonia or hypertonicity. Differences of breath-holding spells from generalized seizures are noted.

An encyclopedia entry for "atypical absence" is presented. It offers clinical information on atypical absence seizure, which is characterized with staring, eyelid fluttering and activity interruption or conversation. It is associated with an irregular generalized 1.5 to 2.5 hertz (Hz) spike-wave discharge. Atypical absence seizure is said to be difficult to distinguish such type of epilepsy from complex partial seizures or other seizure types.