Les malaises de l’enfants sont fréquents. Le terme de malaise peut correspondre à un ensemble de symptômes: accès de pâleur, étourdissement, hypotonie, hypertonie, troubles visuels, difficultés respiratoires, allant parfois jusqu’à la perte de connaissance. La syncope est une entité particulière ou l’enfant perd connaissance sans aucun signe annonciateur.

Certains contextes vont orienter vers une cause cardiaque:

– Les antécédents personnels de maladie chez l’enfant: maladie cardiaque connue, trouble du rythme suivi, maladie génétique.

– Les antécédants familiaux de morts suite inexpliqué chez des sujets jeunes pouvant nous orienter vers des pathologies héréditaires.

– Le contexte du malaise: Un malaise survenant pendant un effort physique doit absolument imposer la réalisation d’examens poussés à la recherche d’un  trouble du rythme ou d’une maladie du muscle cardiaque. 

– La description du malaise est essentielle. La survenue du malaise de façon brutale sans signe annonciateurs ou alors précédé de douleur thoraciques ou palpitation est souvent du à un problème cardiaque. 

 

Les causes non cardiaques sont fréquentes également:

– Certains malaises sont d’origine neurologiques (crise d’épilepsie, vertige, traumatisme crânien)

– Les attaques de paniques ou crises d’angoisses peuvent déclencher des symptômes mimant un trouble cardiaque ou respiratoire (tachycardie, palpitations, gène respiratoire). 

Le malaise vagal est une entité particulière qui représente la cause la plus fréquente de malaise chez l’enfant. Il est caractérisé par des signes annonciateurs classiques: sueurs, tachycardie, flou visuel, sensation de chaleur, jambes en cotons. Le contexte déclenchant est également classique: douleur intense, émotion vive, anxiété, contrariété, chaleur foule. Il s’agit d’un malaise sans risque mais qui peut se répéter et nécessiter parfois un apprentissage pour éviter les facteurs favorisants et éduquer l’enfant pour apprendre à se maitriser avant de perdre connaissance. 

En fonction du contexte, le cardiopédiatre vous proposera des examens adaptés à la situation de votre enfant: échographie cardiaque, éléctricardiogramme, Holter-ECG, test d’effort, tests médicamenteux, voir une étude éléctrique plus poussée par cathétérisme. 

A retenir

Les malaises de l’enfants sont fréquents et sont dans la majorité des cas bénins. Il existe des malaises d’origine non cardiaque. Un bilan cardiologique vous permettra d’éliminer une cause cardiaque. 

Certaines situations doivent alerter et faire consulter en urgence: malaise au cours d’un effort, malaise brutal sans signe annonciateurs ou précédé de sensation de palpitation, maladie cardiaque connue chez l’enfant, antécédent de mort subite dans la famille

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