Exercise Induced Syncope

Aka: Exercise Induced Syncope, Syncope in Athletes, Exertional Syncope, Effort Syncope, Exercise-Associated Collapse, Heat Syncope

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II. Definitions

  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 (Exercise collapse, Heat Syncope)
    1. Typically benign cause
    2. Transient Orthostatic Hypotension
      1. Often occurs with Exercise in hot environments, with vasodilation and increased sweating
      2. Worse with prolonged standing that results in lower extremity venous pooling
      3. Vasovagal episode related to sudden decrease in venous return
      4. Secondary to volume depletion, post-exercise Bradycardia and peripheral vasodilation

IV. Symptoms

  1. Light headedness, Orthostasis or Dizziness immediately following Exercise
  2. Transient loss of consciousness

V. Exam

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

VI. 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

VII. Precautions: Red Flags suggestive of cardiogenic Syncope

  1. Syncope during Exercise (see above) in contrast to the typically benign Syncope that follows Exercise
  2. Cardiovascular Risk Factors
  3. Advanced age
  4. Cardiac symptoms follow Syncope
  5. Delayed recovery

VIII. Labs

  1. Bedside Glucose
  2. Basic chemistry panel (Serum Electrolytes)
  3. Complete Blood Count
  4. Creatinine Kinase (CPK)

IX. Evaluation

  1. See Syncope
  2. See Heat Illness
  3. Electrocardiogram
    1. See Electrocardiogram in Syncope
  4. Echocardiogram
    1. If indicated

X. Management

  1. Immediate management
    1. See Heat Illness
    2. Position patient supine with legs elevated
    3. Encourage oral hydration
    4. Initiate external cooling if concern for Heat Exhaustion or Heat Stroke
    5. Anticipate symptom resolution in 15-20 minutes
  2. Follow-up
    1. Avoid Exercise and avoid return to sport until evaluation is complete
    2. Evaluate for cardiogenic Syncope if red flags as above
    3. Cardiology Consultation

XI. 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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Related Studies

Ontology: Heat Collapse (C0018845)

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, ﾈｯｾｲｷｮﾀﾞﾂ
German Hitzekollaps, Hitzesynkope
Czech Kolaps z horka, Synkopa z horka
Korean 열실신
Hungarian Hőguta, Hő okozta ájulás
Norwegian Hetekollaps
Derived from the NIH UMLS (Unified Medical Language System)

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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