Incidence and hemodynamic characteristics of near-fainting in healthy 6- to 16-year old subjects

Objectives. We studied the incidence and hemodynamic characteristics of near-fainting under orthostatic stress in healthy children and teenagers. Background. Orthostatic stress testing is increasingly used to identify young subjects with unexplained syncope. However, the associated incidence of syncope and hemodynamic responses in normal young subjects are not well known. Methods. Eighty-four healthy subjects 6 to 16 years old performed forced breathing, stand-up and 70° tilt-up tests. An intravenous line to sample blood for biochemical assessment of sympathetic function was introduced between the stand-up and tilt-up tests. Finger arterial pressure was measured continuously. Left ventricular stroke volume was computed from the pressure pulsations. Results. Sixteen of the 84 subjects were excluded because of technical problems. The incidence of near-fainting response in the remaining 68 subjects was 10% (7 of 68) for the stand-up test and 40% (29 of 68) for the tilt-up test. Baseline parasympathetic and sympathetic activity of nonfainting and near-fainting subjects was not different. Near-fainting was characterized by attenuated systemic vasoconstriction and exaggerated tachycardi that occurred as early as 1 min after return to the upright position. On tilt-up, plasm adrenaline levels increased by factor of 2, with slightly higher increments in the near-fainting subjects. Conclusions. Inadequate vasoconstriction is the common underlying mechanism of near-fainting in young subjects. The remarkably high incidence of near-fainting during the tilt-up test after intravascular instrumentation raises serious doubts about the utility of this procedure in evaluating syncope of unknown origin in young subjects.