Pediatric Syncope: Simple vs. Sinister

A 12-year-old girl with a history of loss of consciousness presents. The loss of consciousness occurred on a warm summer day while she was standing in line for a roller coaster ride. She recalls feeling lightheaded, sweaty, and nauseated before seeing black. According to her parents, she was unconscious for approximately 30 sec and spontaneously regained consciousness with no injury, incontinence, or shaking of her limbs. The event occurred at 11:30 a.m.; at 8 a.m., she had drunk 10 oz (295 mL) of apple juice and ate a donut for breakfast. She has no history of syncope or significant medical problems. A thorough cardiac family history identifies none of the following: congenital heart defects, myocardial infarctions at a young age (<50 years), cardiomyopathy, arrhythmias, or sudden unexplained or cardiac death. Her mother fainted a few times as a teenager.

The patient's vital signs and physical examination findings are unremarkable. A 12-lead electrocardiogram (ECG) is obtained (Figure 1).

Figure 1

Figure 1

Which one of the following next steps in management and evaluation is most appropriate?

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