Exercise Induced Syncope

Aka: Exercise Induced Syncope, Syncope in Athletes, Exertional Syncope, Effort Syncope

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II. Definition

  1. Exercise Related Syncope
    1. Loss of consciousness associated with Exercise

III. History: Timing of Syncope

  1. Most important to distinguish timing of syncopal event
    1. Syncope during Exercise is ominious compared with the relatively benign post-ExerciseSyncope
  2. Syncope during Exercise (Exertional Syncope)
    1. True Syncope during Exercise is rare and should be thoroughly evaluated
    2. High risk for serious cause
    3. Consider equivalent of transient sudden death
  3. Syncope following Exercise (Typically benign cause)
    1. Vasovagal episode related to sudden decrease in venous return
    2. Secondary to post-exercise Bradycardia and vasodilation

IV. Exam

  1. See Syncope
  2. Vital Signs (Identify Hypotension, Tachycardia)
  3. Thorough examination (especially cardiovascular)

V. Causes: Exertional Syncope (Syncope during Exercise)

  1. See Arrhythmias in Athletes
  2. See Sudden Death in Athletes
  3. Cardiovascular - Arrhythmia
    1. Arrhythmogenic Right Ventricular Dysplasia (ARVD)
    2. Long QT Syndrome
    3. Brugada Syndrome
    4. Wolff-Parkinson-White Syndrome (WPW Syndrome)
  4. Cardiovascular - Valvular disease
    1. Aortic Stenosis
    2. Mitral Valve Prolapse
    3. Ebstein's Anomaly of the Tricuspid Valve
  5. Cardiovascular - structural
    1. Hypertrophic Cardiomyopathy
    2. Coronary Artery Disease or Coronary Artery Abnormalities
    3. Myocarditis
    4. Marfan's Syndrome
  6. Miscellaneous causes in athletes
    1. Heat Stroke
    2. Hypoglycemia
    3. Hyponatremia
    4. Anaphylaxis

VI. Labs

  1. Bedside Glucose
  2. Basic chemistry panel (Serum electrolytes)
  3. Complete Blood Count

VII. Evaluation

  1. See Syncope
  2. Echocardiogram
  3. Electrocardiogram
    1. See Electrocardiogram in Syncope

VIII. Management

  1. Avoid Exercise and return to sport until evaluation is complete
  2. Cardiology Consultation

IX. References

  1. Spangler and Baird in Herbert (2014) EM:Rap 14(2): 7-8
  2. Colivicchi (2004) Eur Heart J 25(19): 1749-53 [PubMed]

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Ontology: Syncope, Effort (C0235242)

Concepts Sign or Symptom (T184)
MSH D013575
SnomedCT 31457007
English SYNCOPE EXERTIONAL, Syncope exertional, Effort Syncope, Effort Syncopes, Syncopes, Effort, Effort syncope, Exertional syncope, Syncope on exertion, Effort syncope (disorder), Effort syncope (finding), Syncope, Effort
Dutch syncope bij inspanning
French Syncope à l'effort, Syncope d'effort, SYNCOPE D'EFFORT
German Synkope infolge Belastung, SYNKOPE BEI BELASTUNG
Portuguese Síncope de esforço, SINCOPE DE ESFORCO
Spanish Síncope de esfuerzo, SINCOPE DE ESFUERZO, síncope por esfuerzo, síncope por esfuerzo (hallazgo), síncope por esfuerzo (trastorno)
Japanese 労作性失神, ﾛｳｻｾｲｼｯｼﾝ
Czech Námahová synkopa
Hungarian Terheléses syncope
Norwegian Anstrengelsessynkope, Synkope, anstrengelses-
Italian Sincope da sforzo
Derived from the NIH UMLS (Unified Medical Language System)

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