RESUMO
OBJECTIVE: To identify characteristics that distinguish cardiac from vasovagal syncope. STUDY DESIGN: We compared characteristics of patients ≤18 years of age with vasovagal and cardiac syncope. Vasovagal syncope subjects represented all patients presenting to outpatient cardiology during a 1-year period for initial evaluation of syncope diagnosed with vasovagal syncope. Cardiac patients were all patients identified by review of diagnoses known to include syncope as a symptom who presented with syncope to the emergency department or inpatient or outpatient cardiology during a 10-year period identified with cardiac etiology. RESULTS: There were 89 patients 4-18 years of age with vasovagal syncope and 17 patients 4 months to 17 years of age with cardiac syncope. When we compared patients with cardiac syncope to those with vasovagal syncope, we found that syncope surrounding activity was present in 65% vs 18% (P < .001), family history of cardiac disease or sudden cardiac death was identified in 41% vs 25% (P = .2), abnormal findings on the physical examination supporting cardiac diagnosis were present in 29% vs 0% (P < .001), and abnormal findings on electrocardiograms were found in 76% vs 0%, respectively (P < .001). Screening for cardiac disease using any 1 of these 4 characteristics had a sensitivity of 100% and specificity of 60%. Using this screening rule, we found that 60% of patients with vasovagal syncope would not have been referred to cardiology. CONCLUSIONS: Cardiac and vasovagal syncope have dramatic differences in presentation. A screening rule that uses historic features, physical examination findings, and electrocardiogram will accurately separate patients requiring further evaluation for cardiac etiology from those with vasovagal syncope in whom cardiology referral is unnecessary.
Assuntos
Síncope Vasovagal/diagnóstico , Síncope/diagnóstico , Adolescente , Cardiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
OBJECTIVE: To estimate the prevalence and incidence of hypertension and prehypertension and associated factors in adolescent girls. STUDY DESIGN: A total of 2368 girls (49% Caucasian, 51% African-American) aged 9 or 10 years enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study had blood pressure, height, and weight measured at annual visits through age 18 to 19 years. Prevalence and incidence of hypertension and prehypertension were calculated. RESULTS: On the basis of 2 visits, hypertension prevalence was approximately 1% to 2% in African-American girls and 0.5% in Caucasian girls. Incidence in 8 years was 5.0% and 2.1%, respectively. Obese girls had higher prevalence (approximately 6-fold higher) and incidence (approximately 2- to 3-fold higher) compared with girls of normal weight. Similar patterns were found for prehypertension, except that prehypertension occurred more in older girls than younger girls. Dietary factors (lower intake of fiber, potassium, magnesium, and calcium, and higher intake of caffeine and calories) were each associated with hypertension incidence (all P<.05). In multivariate analysis, higher body mass index (P<.001) and lower potassium intake (P=.023) were independently associated with incidence of hypertension. CONCLUSIONS: Hypertension occurred early in childhood and was related to obesity and other modifiable lifestyle factors. Clinicians should monitor blood pressure during childhood and provide focused diet and physical activity guidance to minimize the development of hypertension.
Assuntos
Hipertensão/epidemiologia , Adolescente , Feminino , Humanos , Incidência , PrevalênciaRESUMO
OBJECTIVE: To review the efficacy of ezetimibe monotherapy for treatment of hypercholesterolemia in pediatric patients. STUDY DESIGN: This is a retrospective review of all pediatric patients who received ezetimibe monotherapy as treatment for hypercholesterolemia and for whom follow-up clinical and lipid results were available. Of 36 identified patients, 26 had lipoprotein profiles suggestive of familial hypercholesterolemia (FH), and 10 had profiles suggestive of familial combined hyperlipidemia (FCHL). RESULTS: After a mean 105 days of treatment with ezetimibe (range, 32-175 days), total cholesterol (TC) levels decreased from 7.3 +/- 1.0 mmol/L to 5.7 +/- 1.0 mmol/L (P < .0001), and low-density lipoprotein cholesterol (LDL-C) levels decreased from 5.3 +/- 0.9 mmol/L to 3.9 +/- 0.8 (P < .0001) in patients with FH. In patients with FCHL, TC levels decreased from 6.4 +/- 2.0 mmol/L to 5.6 +/- 0.4 mmol/L (P < or = .002), and LDL-C levels decreased from 4.7 +/- 1.0 mmol/L to 3.8 +/- 0.6 mmol/L (P < or = .005). For all patients, the mean decrease in individual LDL-C values was 1.5 +/- 0.9 mmol/L or 28%. There was no significant change in triglyceride or high-density lipoprotein cholesterol levels with ezetimibe. Patients were maintained on ezetimibe with no adverse effects attributable to the medication for as long as 3.5 years. At a mean of 13.6 months (range, 1-44 months) after the initiation of ezetimibe, LDL-C levels remained decreased at 4.0 +/- 0.6 mmol/L. CONCLUSIONS: In this small retrospective series of children and adolescents with hypercholesterolemia, ezetimibe was safe and effective in lowering LDL-C levels.
Assuntos
Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Hiperlipidemia Familiar Combinada/tratamento farmacológico , Adolescente , Criança , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Ezetimiba , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/genética , Hiperlipidemia Familiar Combinada/sangue , Masculino , Triglicerídeos/sangueRESUMO
OBJECTIVE: To evaluate the hypothesis that white coat hypertension (WCH) represents a prehypertensive state by correlating ambulatory blood pressure monitoring (ABPM) results with BP response to treadmill exercise (TE) and echocardiographic measurement of left ventricular mass index (LVMI) in children with high blood pressure (HBP). STUDY DESIGN: We evaluated 119 consecutive children age 6 to 18 years (mean = 13.3 years; 65% male) referred for HBP. Office systolic BP (SBP) exceeded the 95th percentile for age/sex/height in all of the children; 10% also had elevated diastolic BP (DBP). WCH was defined as elevated office SBP +/- elevated DBP with normal mean awake ABPM-SBP. ABPM classified 62 subjects as having WCH and 57 as having HBP. RESULTS: Office BP did not differ between the 2 groups. As defined, awake ABPM-SBP was lower in the WCH group (males: HBP, 142 +/- 12 vs WCH, 124 +/- 5; females: HBP, 137 +/- 8 vs WCH, 121 +/- 5). Awake and asleep DBP and asleep SBP were significantly lower in the WCH group. On TE, maximal SBP exceeded norms for age/sex/body surface area in 63% of the HBP group and 38% of the WCH group. LVMI exceeded the 95th percentile for age/sex in 59% of the males and 90% of the females in the HBP group and in 33% of the males and 36% of the females in the WCH group. CONCLUSIONS: Exaggerated exercise BP and/or increased LVMI in 62% of those subjects with WCH suggest that this diagnosis in children may represent a prehypertensive state.