urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2023-22-3-137-144urmj-1273Research ArticleЛитературные обзоры | Literature reviewsLiterature reviewsКардиалгии и обмороки – актуальная проблема педиатрииPediatric chest pain and synopsis is a current problem of pediatricsСозоновА. В.SozonovA. V.

Андрей Викторович Созонов – заведующий городским детским кардиологическим центром, врачфункциональной диагностики

Екатеринбург

Andrey V. Sozonov – Head of the city children’s cardiology department, Doctor of functional diagnostics

Ekaterinburg

sozonov-av@yandex.ruhttps://orcid.org/0000-0003-4588-5909ЦарьковаС. А.TsarkovaS. A.

Софья Анатольевна Царькова – доктор медицинских наук, профессор

Екатеринбург

Sofya A. Tsarkova – Doctor of Medical Sciences, Professor

Ekaterinburg

tsarkova_ugma@bk.ruТруноваЮ. А.TrunovaY. A.

Юлия Александровна Трунова – кандидат медицинских наук

Екатеринбург

Yuliya A. Trunova – PhD in medicine

Ekaterinburg

trunovaj@bk.ruДетская городская клиническая больница № 11РоссияChildren’s City Clinical Hospital № 11Russian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation202330062023223137144Copyright © Созонов А.В., Царькова С.А., Трунова Ю.А., 20232023Созонов А.В., Царькова С.А., Трунова Ю.А.Sozonov A.V., Tsarkova S.A., Trunova Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1273Введение

Введение. Кардиалгии являются распространенной причиной обращения за медицинской помощью в практике педиатра и детского кардиолога. Сочетание кардиалгий и обмороков у детей могут представлять угрозу для здоровья, приводя к возможной травматизации, являясь фактором страха и беспокойства в таких семьях. Недостаточные сведения о патофизиологических основах развития кардиалгий и обмороков у детей, отсутствие четких критериев, позволяющих их прогнозировать и профилактировать, явились основанием для подробного изучения литературы, касающейся этого вопроса.

Цель работы – систематизировать современные литературные данные о причинах кардиалгий и обмороков у детей и определить направления дальнейшего изучения проблемы для усовершенствования наблюдения педиатрами и детскими кардиологами.

Материалы и методы

Материалы и методы. Проведен поиск научных статей по ключевым словам кардиалгии (pediatric chest pain) и обморок (syncope) у детей в базах данных Pubmed, UpToDate 2022, Customer Service, РИНЦ. Для анализа отобрано 60 публикаций.

Результаты и обсуждение

Результаты и обсуждение. Кардиалгия – боль в области сердца, которая в сочетании с обмороками может являться симптомом большого количества заболеваний, что определяет различный подход со стороны врачей-специалистов, занимающихся проблемами лечения заболеваний сердечно-сосудистой системы, и требует специальной диагностики. Для кардиалгий характерен полиморфизм как жалоб и субъективных ощущений, так и объективных данных. Все это обусловлено разнообразием этиопатогенеза данного симптома. Заключение. Кардиалгии являются актуальной проблемой в педиатрической практике. Представленный обзор литературы суммирует накопленную в течение нескольких лет информацию по диагностике кардиалгий и обмороков у детей и определяет траекторию дальнейшего изучения проблемы.

Introduction

Introduction. Cardialgia is a common reason for seeking medical care in the practice of the pediatrician and pediatric cardiologist. The combination of cardialgia and syncope in children can pose a health risk, leading to possible injuries, and is a factor of fear and anxiety in these families. Insufficient information on the pathophysiological basis of the development of cardialgia and syncope in children and the absebce of clear criteria for their prognosis and prevention were the reasons for a detailed study of the literature related to this issue.

The aim of the work was to systematize the current literary data on the causes of cardialgia and syncope in children and to determine directions for further study of the problem to improve monitoring by pediatricians and pediatric cardiologists.

Materials and methods

Materials and methods. We searched for scientific articles using the keywords pediatric chest pain and syncope in the Pubmed, UpToDate 2022, Customer Service, and RSCI databases. Sixty publications were selected for analysis.

Results and discussion

Results and discussion. Cardialgia is pain in the heart region, which in combination with fainting can be a symptom of a large number of diseases, which determines the different approach of medical specialists involved in the treatment of diseases of the cardiovascular system, and requires a special diagnosis. Cardialgia is characterized by polymorphism of both complaints and subjective sensations, and objective data. All this is caused by a variety of etiopathogenesis of this symptom.

Conclusion

Conclusion. Cardialgia is a current problem in pediatric practice. This literature review summarizes the information accumulated over several years on the diagnosis of cardialgia and syncope in children and determines the trajectory of further study of the problem.

кардиалгияобморокдетиподросткиcardialgiapediatric chest pain faintingchildrenadolescentsReferencesFriedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013;163(3):896−901.e1−3. https://doi.org/10.1016/j.jpeds.2013.05.001.Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013;163(3):896−901.e1−3. https://doi.org/10.1016/j.jpeds.2013.05.001.Пшеничная Е.В., Бордюгова Е.В., Дубовая А.В. с соавт. Кардиалгия у детей: междисциплинарный подход. Вопросы детской диетологии. 2016;14(2):55−56.Pshenichnaya EV, Bordyugova EV, Dubovaya AV et al. Cardialgia in children: an interdisciplinary approach. Voprosy of pediatric dietetics = Voprosy detskoj dietologii. 2016;14(2):55−56. (In Russ.).Kim H, Eun LY. Assessment of cardiac function in syncopal children without organic causes. Clin Exp Pediatr. 2021;64(11):582−587. https://doi.org/10.3345/cep.2019.01046.Kim H, Eun LY. Assessment of cardiac function in syncopal children without organic causes. Clin Exp Pediatr. 2021;64(11):582−587. https://doi.org/10.3345/cep.2019.01046.Banerjee MM, Ramesh Iyer V, Nandi D et al. Reliability of left ventricular hypertrophy by ECG criteria in children with syncope: Do the criteria need to be revised? Pediatr Cardiol. 2016;37(4):722–727. https://doi.org/10.1007/s00246-015-1336-9.Banerjee MM, Ramesh Iyer V, Nandi D et al. Reliability of left ventricular hypertrophy by ECG criteria in children with syncope: Do the criteria need to be revised? Pediatr Cardiol. 2016;37(4):722–727. https://doi.org/10.1007/s00246-015-1336-9.Fu Q, Levine BD. Pathophysiology of neurally mediated syncope: role of cardiac output and total peripheral resistance. Auton Neurosci. 2014;184:24–26. https://doi.org/10.1016/j.autneu.2014.07.004.Fu Q, Levine BD. Pathophysiology of neurally mediated syncope: role of cardiac output and total peripheral resistance. Auton Neurosci. 2014;184:24–26. https://doi.org/10.1016/j.autneu.2014.07.004.Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, Bradley TJ et al. Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging. 2015;8(2):e002167. https://doi.org/10.1161/CIRCIMAGING.114.002167.Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, Bradley TJ et al. Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging. 2015;8(2):e002167. https://doi.org/10.1161/CIRCIMAGING.114.002167.Verghese GR, Friedman KG, Rathod RH et al. Resource utilization reduction for evaluation of chest pain in pediatrics using a novel Standardized Clinical Assessment and Management Plan (SCAMP) J Am Heart Assoc. 2012;1(2):jah3-e000349. https://doi.org/10.1161/JAHA.111.000349.Verghese GR, Friedman KG, Rathod RH et al. Resource utilization reduction for evaluation of chest pain in pediatrics using a novel Standardized Clinical Assessment and Management Plan (SCAMP) J Am Heart Assoc. 2012;1(2):jah3-e000349. https://doi.org/10.1161/JAHA.111.000349.ESC (European Sociaty of Cardiology) 2018 Guidelines for Diagnosis/Management of Syncope ESC Clinical Practice Guidelines URL: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of.ESC (European Sociaty of Cardiology) 2018 Guidelines for Diagnosis/Management of Syncope ESC Clinical Practice Guidelines URL: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of.Галактионова М.Ю., Воронина Н.В., Рахимова А.Л., Миронова О.И. Нейропротекторная терапия в лечении синдрома вегетативных дисфункций у детей и подростков. Лечащий врач. 2013;1:92–96.Galaktionova M.Y., Voronina N.V., Rakhimova A.L., Mironova O.I. Neuroprotective therapy in the treatment of vegetative dysfunction syndrome in children and adolescents. Treating Physician = Lechashhij vrach. 2013;1:92–96. (In Russ.).Barbic F, Dipaola F, Casazza G et al. Syncope in a working-age population: recurrence risk and related risk factors. J Clin Med. 2019;8(23):150. https://doi.org/10.3390/jcm8020150.Barbic F, Dipaola F, Casazza G et al. Syncope in a working-age population: recurrence risk and related risk factors. J Clin Med. 2019;8(23):150. https://doi.org/10.3390/jcm8020150.Школьникова М.А. Синкопальные состояния у детей: классификация и диагностика. Здоровья Украiни. 2008;5(1):33−37.Shkolnikova MA. Syncopal conditions in children: classification and diagnosis. Zdorov’ya Ukrainy. 2008;5(1):33−37. (In Russ.).Вегетативные расстройства: клиника, лечение, диагностика. Под ред. А.М. Вейна. М : Медицинское информационное агентство ; 2000. 752 с.Autonomic disorders: clinic, treatment, diagnosis. Ed. by AM Vein. М. : Medical Information Agency ; 2000. 752 p. (In Russ.).Руксин В.В. Краткое руководство по неотложной кардиологии. СПб : ИнформМед ; 2009. 415 с.Ruxin VV. Concise Guide to Emergency Cardiology. SPb : InformMed ; 2009. 415 p. (In Russ.).Мутафьян О.А. Неотложная кардиология детского и подросткового возраста. Спб : Фолиант ; 2013. 336 с.Mutafyan OA. Emergency cardiology in children and adolescents. Spb : Foliant ; 2013. 336 p. (In Russ.).Оганов Р.Г., Фомина И.Г. Болезни сердца. М : Литтерра ; 2006. 1328 с.Oganov RG, Fomina IG. Heart Diseases. M : Litterra ; 2006. 1328 p. (In Russ.).Патофизиология заболеваний сердечно-сосудистой системы. Под ред. Л. Лилли. М : БИНОМ Лаборатория знаний ; 2007. 598 с.Pathophysiology of Diseases of the Cardiovascular System. Edited by L. Lilly. M : BINOM Laboratory of Knowledge ; 2007. 598 p. (In Russ.).Хоффман Дж. Детская кардиология. М : Практика ; 2006. 543 с.Hoffman J. Pediatric Cardiology. M : Practice ; 2006. 543 p. (In Russ.).Скуратова Н.А. Синкопальные состояния у детей. Медицинские новости. 2010;2:19−23.Skuratova NA. Syncopal conditions in children. Medical News = Medicinskie novosti. 2010;2:19−23. (In Russ.).Окороков А.Н., Базенко Н.П. Нейроциркулярная дистония. М : Медицинская литература ; 2004. 192 с.Okorokov AN, Bazenko NP. Neurocircular Dystonia. M : Medical literature ; 2004. 192 p. (In Russ.).Воробьева О.В. Синкопальные состояния. Клиническая неврология. 2006;2:40−44.Vorobyeva OV. Syncopal states. Clinical Neurology. 2006;2:40−44. (In Russ.).Созонов А.В., Чередниченко А.М., Трунова Ю.А. Опыт применения тилт-теста у детей с кардиалгиями и обмороками. Уральский медицинский журнал. 2015;4:118−122.Sozonov AV, Cherednichenko AM, Trunova SA Experience of using the tilt test in children with cardialgia and syncope. Ural Medical Journal. 2015;4:118−122. (In Russ.).Белозеров Ю.М. Детская кардиология. М : МЕДпресс-информ ; 2004. С. 9−221.Belozerov YuM. Pediatric Cardiology. M : MEDpress-inform ; 2004. pp. 9−221. (In Russ.).Самсыгина Г.А., Щербакова М.Ю. Кардиология и ревматология детского возраста. М : Медпрактика ; 2004. 145 с.Samsygina GA, Shcherbakova MY. Cardiology and rheumatology of childhood. M : Medpraktika ; 2004. 145 p. (In Russ.).Руксин В.В. Краткое руководство по неотложной кардиологии. СПб : ИнформМед ; 2009. 415 с.Ruxin VV. Concise Guide to Emergency Cardiology. Saint Petersburg : InformMed ; 2009. 415 p. (In Russ.).Мутафьян О.А. Детская кардиология. М : ГЭОТАР-Медиа ; 2009. 504 с.Mutafyan OA. Pediatric Cardiology. M : GEOTAR-Media ; 2009. 504 p. (In Russ.).Макаров Л.М. Тилт-тест в оценке синкопальных состояний у детей и подростков. Практическая медицина. 2015;3−1(88):15.Makarov L.M. Tilt-test in the assessment of syncopal states in children and adolescents. Practical Medicine = Prakticheskaja medicina. 2015;3−1(88):15. (In Russ.).Wang Y, Wang Sh, Zou R et al. The relationship between unexplained chest pain in children and head-up tilt test. Front Pediatr. https://doi.org/10.3389/fped.2022.901919.Wang Y, Wang Sh, Zou R et al. The relationship between unexplained chest pain in children and head-up tilt test. Front Pediatr. https://doi.org/10.3389/fped.2022.901919.Brignole M, Moya A, de Lange FJ et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39:1883–1948. https://doi.org/10.1093/eurheartj/ehy037.Brignole M, Moya A, de Lange FJ et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39:1883–1948. https://doi.org/10.1093/eurheartj/ehy037.Котова О.В., Акарачкова Е.С., Вершинина С.В., Рябоконь И.В. Кардиалгии у детей и подростков. Вопросы диагностики в педиатрии. 2013;5(4):64−68.Kotova OV, Akarachkova ES, Vershinina SV, Ryabokon IV. Cardialgia in children and adolescents. Diagnostic Issues in Pediatrics = Voprosy diagnostiki v pediatrii. 2013;5(4):64−68. (In Russ.).Пшеничная Е.В., Бордюгова Е.В., Дубовая А.В. с соавт. Кардиалгия у детей: междисциплинарный подход. Вопросы детской диетологии. 2016;14(2):55−56.Pshenichnaya EV, Bordyugova EV, Dubovaya AV et al. Cardialgia in children: an interdisciplinary approach. Voprosy of pediatric dietetics = Voprosy detskoj dietologii. 2016;14(2):55−56. (In Russ.).Беляев А.А., Котова О.В., Акарачкова Е.С., Артеменко А.Р. Боль в груди: в фокусе несердечные кардиалгии. Русский медицинский журнал. Медицинское обозрение. 2018;2(11):9−34.Belyaev AA, Kotova OV, Akarachkova ES, Artemenko AR. Chest pain: noncardiac cardialgia in focus. Russian Medical Journal. Medical Review = Russkij medicinskij zhurnal. Medicinskoe obozrenie. 2018;2(11):9−34. (In Russ.).Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128:e1062–1068. https://doi.org/10.1542/peds.2011-0408.Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128:e1062–1068. https://doi.org/10.1542/peds.2011-0408.Chen L, Duan H, Li G, Li X. The etiology of chest pain in children admitted to cardiology clinics and the use echocardiography to screen for cardiac chest pain in children. Front Pediatr. 2022;10:882022. https://doi.org/10.3389/fped.2022.882022.Chen L, Duan H, Li G, Li X. The etiology of chest pain in children admitted to cardiology clinics and the use echocardiography to screen for cardiac chest pain in children. Front Pediatr. 2022;10:882022. https://doi.org/10.3389/fped.2022.882022.Pissarra R, Pereira M, Amorim R et al. Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital. Porto Biomed J. 2022;7(3):e150. https://doi.org/10.1097/j.pbj.0000000000000150.Pissarra R, Pereira M, Amorim R et al. Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital. Porto Biomed J. 2022;7(3):e150. https://doi.org/10.1097/j.pbj.0000000000000150.Chen L, Duan H, Li X et al. The causes of chest pain in children and the criteria for targeted myocardial enzyme testing in identifying the causes of chest pain in children. Front Cardiovasc Med. 2021;8:582129. https://doi.org/10.3389/fcvm.2021.582129.Chen L, Duan H, Li X et al. The causes of chest pain in children and the criteria for targeted myocardial enzyme testing in identifying the causes of chest pain in children. Front Cardiovasc Med. 2021;8:582129. https://doi.org/10.3389/fcvm.2021.582129.Aygun E, Aygun ST, Uysal T et al. Aetiological evaluation of chest pain in childhood and adolescence. Cardiol Young. 2020;30(5):617−623. https://doi.org/10.1017/S1047951120000621.Aygun E, Aygun ST, Uysal T et al. Aetiological evaluation of chest pain in childhood and adolescence. Cardiol Young. 2020;30(5):617−623. https://doi.org/10.1017/S1047951120000621.Gesuete V, Fregolent D, Contorno S et al. Follow-up study of patients admitted to the pediatric emergency department for chest pain. Eur J Pediatr. 2020;179:303–308. https://doi.org/10.1007/s00431-019-03495-5.Gesuete V, Fregolent D, Contorno S et al. Follow-up study of patients admitted to the pediatric emergency department for chest pain. Eur J Pediatr. 2020;179:303–308. https://doi.org/10.1007/s00431-019-03495-5.Mohan S, Nandi D, Stephens P et al. Implementation of a clinical pathway for chest pain in a pediatric emergency department. Pediatr Emerg Care. 2018;34(11):778−782. https://doi.org/10.1097/PEC.0000000000000861.Mohan S, Nandi D, Stephens P et al. Implementation of a clinical pathway for chest pain in a pediatric emergency department. Pediatr Emerg Care. 2018;34(11):778−782. https://doi.org/10.1097/PEC.0000000000000861.Anderson JB, Willis M, Lancaster H et al. The evaluation and management of pediatric syncope. Pediatr Neurol. 2016;55:6–13. https://doi.org/10.1016/j.pediatrneurol.2015.10.018.Anderson JB, Willis M, Lancaster H et al. The evaluation and management of pediatric syncope. Pediatr Neurol. 2016;55:6–13. https://doi.org/10.1016/j.pediatrneurol.2015.10.018.Chun JH, Kim TH, Han MY et al. Analysis of clinical characteristics and causes of chest pain in children and adolescents. Korean J Pediatr. 2015;58(11):440−445. https://doi.org/10.3345/kjp.2015.58.11.440.Chun JH, Kim TH, Han MY et al. Analysis of clinical characteristics and causes of chest pain in children and adolescents. Korean J Pediatr. 2015;58(11):440−445. https://doi.org/10.3345/kjp.2015.58.11.440.Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young. 2013;23(3):361−367. https://doi.org/10.1017/S1047951112000881.Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young. 2013;23(3):361−367. https://doi.org/10.1017/S1047951112000881.Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young. 2013;23(3):361−367. https://doi.org/10.1017/S1047951112000881.Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young. 2013;23(3):361−367. https://doi.org/10.1017/S1047951112000881.Lee JL, Gilleland J, Campbell RM et al. Health care utilization and psychosocial factors in pediatric noncardiac chest pain. Health Psychol. 2013;32(3):320–327. https://doi.org/10.1037/a0027806.Lee JL, Gilleland J, Campbell RM et al. Health care utilization and psychosocial factors in pediatric noncardiac chest pain. Health Psychol. 2013;32(3):320–327. https://doi.org/10.1037/a0027806.Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128(5):e1062–1068. https://doi.org/10.1542/peds.2011-0408.Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128(5):e1062–1068. https://doi.org/10.1542/peds.2011-0408.Ким С.В. Некоторые аспекты кардиалгий в практике врача-педиатра. West Kazakhstan Medical Journal. 2010;2(26):35−37.Kim S.V. Some aspects of cardialgia in the practice of a pediatrician. West Kazakhstan Medical Journal. 2010;2(26):35−37. (In Russ.).Massin MM, Bourguignont A, Coremans C et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila). 2004;43(3):231−238. https://doi.org/10.1177/000992280404300304.Massin MM, Bourguignont A, Coremans C et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila). 2004;43(3):231−238. https://doi.org/10.1177/000992280404300304.Karakurt C, Karademir S, Oguz D et al. International Chest Pain in Children. Pediatrics. 2004;19(3):179.Karakurt C, Karademir S, Oguz D et al. International Chest Pain in Children. Pediatrics. 2004;19(3):179.Rowe BH, Dulberg CS, Peterson RG et al. Characteristics of children presenting with chest pain to a pediatric emergency department. CMAJ. 1990;143(5):388−394.Rowe BH, Dulberg CS, Peterson RG et al. Characteristics of children presenting with chest pain to a pediatric emergency department. CMAJ. 1990;143(5):388−394.Sanatani S, Chau V, Fournier A et al. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association position statement on the approach to syncope in the pediatric patient. Can J Cardiol. 2017;33:189–198. https://doi.org/10.1016/j.cjca.2016.09.006.Sanatani S, Chau V, Fournier A et al. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association position statement on the approach to syncope in the pediatric patient. Can J Cardiol. 2017;33:189–198. https://doi.org/10.1016/j.cjca.2016.09.006.Choi SH, Eun LY, Kim NK et al. Myocardial tissue Doppler velocity in child growth. J Cardiovasc Ultrasound. 2016;24(1):40–47. https://doi.org/10.4250/jcu.2016.24.1.40.Choi SH, Eun LY, Kim NK et al. Myocardial tissue Doppler velocity in child growth. J Cardiovasc Ultrasound. 2016;24(1):40–47. https://doi.org/10.4250/jcu.2016.24.1.40.Medow MS, Merchant S, Suggs M et al. Postural heart rate changes in young patients with vasovagal syncope. Pediatrics.2017;139(4):e20163189. https://doi.org/10.1542/peds.2016-3189.Medow MS, Merchant S, Suggs M et al. Postural heart rate changes in young patients with vasovagal syncope. Pediatrics.2017;139(4):e20163189. https://doi.org/10.1542/peds.2016-3189.Caballero L, Kou S, Dulgheru R et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015;16(9):1031–1041. https://doi.org/10.1093/ehjci/jev083.Caballero L, Kou S, Dulgheru R et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015;16(9):1031–1041. https://doi.org/10.1093/ehjci/jev083.Kadappu KK, Thomas L. Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ. 2015;24(3):224–233. https://doi.org/10.1016/j.hlc.2014.10.003.Kadappu KK, Thomas L. Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ. 2015;24(3):224–233. https://doi.org/10.1016/j.hlc.2014.10.003.Miyake CY, Motonaga KS, Fischer-Colbrie ME et al. Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope. Cardiol Young. 2016;26(5):894−900. https://doi.org/10.1017/S1047951115001481.Miyake CY, Motonaga KS, Fischer-Colbrie ME et al. Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope. Cardiol Young. 2016;26(5):894−900. https://doi.org/10.1017/S1047951115001481.Макаров Л.М., Комолятова В.Н., Киселева И.И. Тилт-тест в оценке синкопальных состояний у молодых лиц. Медицинский алфавит. 2018;1(4):15−21.Makarov LM, Komolyatova VN, Kiseleva II. Tilt-test in evaluation of syncopal states in young persons. Medical Alphabet = Medicinskij alfavit. 2018;1(4):15−21. (In Russ.).Wieling W, Krediet P, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond). 2007;112(3):157–165. https://doi.org/10.1042/CS20060091.Wieling W, Krediet P, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond). 2007;112(3):157–165. https://doi.org/10.1042/CS20060091.Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during headup tilt table testing. Pacing Clin Electrophysiol. 1997;20(9 Pt 1):2205–2212. https://doi.org/10.1111/j.1540-8159.1997.tb04238.x.Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during headup tilt table testing. Pacing Clin Electrophysiol. 1997;20(9 Pt 1):2205–2212. https://doi.org/10.1111/j.1540-8159.1997.tb04238.x.Vlahos AP, Kolettis TM. Family history of children and adolescents with neurocardiogenic syncope. Pediatr Cardiol. 2008;29(1):227. https://doi.org/10.1007/s00246-007-9099-6.Vlahos AP, Kolettis TM. Family history of children and adolescents with neurocardiogenic syncope. Pediatr Cardiol. 2008;29(1):227. https://doi.org/10.1007/s00246-007-9099-6.Вегетативные расстройства: клиника, лечение, диагностика. Под ред. А.М. Вейна. М : Медицинское информационное агентство ; 2000. 752 с.Autonomic disorders: clinic, treatment, diagnosis. Edited by A.M. Vein. M : Medical Information Agency ; 2000. 752 p. (In Russ.).Hurst D, Hirsh DA, Oster ME et al. Syncope in the pediatric emergency department − Can we predict cardiac disease based on history alone? J Emerg Med. 2015;49(1):1−7. https://doi.org/10.1016/j.jemermed.2014.12.068.Hurst D, Hirsh DA, Oster ME et al. Syncope in the pediatric emergency department − Can we predict cardiac disease based on history alone? J Emerg Med. 2015;49(1):1−7. https://doi.org/10.1016/j.jemermed.2014.12.068.

The authors declare that there are no conflicts of interest present.