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Drs Mathias Kumpf and Ludger Sieverding et al have presented 2 very
unusual and thought provoking cases of adolescent syncope. They rightly
state that syncope unrelated to exertion is extremely common in
adolescence and is almost invariably a benign event. Time and again
warning signs suggesting the presence of a dangerous underlying mechanism
have been defined. These include syncope induced by exercise, loud noise,
fright or severe emotional distress(1). Electrocardiogram (ECG), cardiac
event monitoring and stress testing are helpful in arriving at a diagnosis
in these atypical patients.
However the use of transthoracic echocardiography in the evaluation
of patients with syncope has been limited and focused on ruling out left
ventricular outflow tract obstruction(2). It is perhaps time to extend
this role to look for anomalous origin of the coronary arteries as a
matter of routine. We welcome and support the authors’ suggestion.
1. McLeod KA. Syncope in childhood. Arch Dis Child. 2003;88: 350-353.
2. Wren C. Cardiac causes for syncope or sudden death in childhood. Arch
Dis Child. 1999; 81: 289-291.
No competing interests
21 May 2006
Dirk Wilson, Orhan Uzun, University Hospital of Wales, Cardiff.
Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, CF72 8XR