Exercise Induced Syncope

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

1. See Also
   1. Syncope
   2. Arrhythmias in Athletes
   3. Sudden Death in Athletes
2. Definition
   1. Exercise Related Syncope
      1. Loss of consciousness associated with Exercise
3. 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
4. Exam
   1. See Syncope
   2. Vital Signs (Identify Hypotension, Tachycardia)
   3. Thorough examination (especially cardiovascular)
5. 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
6. Labs
   1. Bedside Glucose
   2. Basic chemistry panel (Serum electrolytes)
   3. Complete Blood Count
7. Evaluation
   1. See Syncope
   2. Echocardiogram
   3. Electrocardiogram
      1. See Electrocardiogram in Syncope
8. Management
   1. Avoid Exercise and return to sport until evaluation is complete
   2. Cardiology Consultation
9. 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]