III. History: Timing of Syncope
- Most important to distinguish timing of syncopal event
- Syncope during Exercise (Exertional Syncope)
-
Syncope following Exercise (Exercise collapse, Heat Syncope)
- Typically benign cause
- Transient Orthostatic Hypotension
- Often occurs with Exercise in hot environments, with vasodilation and increased sweating
- Worse with prolonged standing that results in lower extremity venous pooling
- Vasovagal episode related to sudden decrease in venous return
- Secondary to volume depletion, post-exercise Bradycardia and peripheral vasodilation
IV. Symptoms
- Light headedness, Orthostasis or Dizziness immediately following Exercise
- Transient loss of consciousness
V. Exam
- See Syncope
- Vital Signs (Identify Hypotension, Tachycardia)
- Thorough examination (especially cardiovascular)
VI. Causes: Exertional Syncope (Syncope during Exercise)
- See Arrhythmias in Athletes
- See Sudden Death in Athletes
- Cardiovascular - Arrhythmia
- Cardiovascular - Valvular disease
- Aortic Stenosis
- Mitral Valve Prolapse
- Ebstein's Anomaly of the Tricuspid Valve
- Cardiovascular - structural
- Miscellaneous causes in athletes
VII. Precautions: Red Flags suggestive of cardiogenic Syncope
VIII. Labs
- Bedside Glucose
- Basic chemistry panel (Serum Electrolytes)
- Complete Blood Count
- Creatinine Kinase (CPK)
IX. Evaluation
- See Syncope
- See Heat Illness
- Electrocardiogram
-
Echocardiogram
- If indicated
X. Management
- Immediate management
- See Heat Illness
- Position patient supine with legs elevated
- Encourage oral hydration
- Initiate external cooling if concern for Heat Exhaustion or Heat Stroke
- Anticipate symptom resolution in 15-20 minutes
- Follow-up
- Avoid Exercise and avoid return to sport until evaluation is complete
- Evaluate for cardiogenic Syncope if red flags as above
- Cardiology Consultation
XI. References
- Spangler and Baird in Herbert (2014) EM:Rap 14(2): 7-8
- Colivicchi (2004) Eur Heart J 25(19): 1749-53 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
MSH | D006359 |
ICD9 | 992.1 |
ICD10 | T67.1 |
SnomedCT | 269424004, 157724009, 89797005 |
English | Collapse, Heat, Effects of heat syncope, Heat Collapse, heat syncope (diagnosis), heat syncope, Syncope - heat, Heat syncope or collapse, Heat syncope &/or collapse, Heat syncope &/or collapse (disorder), Heat syncope/collapse, Heat syncope, Heat collapse, Collapse - heat, Heat syncope (disorder), collapse; heat, heat; collapse, heat; syncope, syncope; heat |
Dutch | hittesyncope, hitteslag, collaps; hitte, hitte; collaps, hitte; syncope, syncope; hitte, Syncope door warmte, Hittecollaps |
French | Syncope de chaleur, Syncope due à la chaleur, Collapsus dû à la chaleur |
Italian | Collasso da calore, Sincope da calore, Collasso da caldo |
Portuguese | Síncope pelo calor, Colapso pelo calor, Colapso Devido ao Calor |
Spanish | Colapso por calor, Síncope por calor, Colapso por Calor, colapso por calor, síncope por calor (trastorno), síncope por calor |
Japanese | 熱性失神, 熱性虚脱, ネッセイシッシン, ネツセイシッシン, ネッセイキョダツ |
German | Hitzekollaps, Hitzesynkope |
Czech | Kolaps z horka, Synkopa z horka |
Korean | 열실신 |
Hungarian | Hőguta, Hő okozta ájulás |
Norwegian | Hetekollaps |
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 |