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Exercise Induced Syncope
Aka: Exercise Induced Syncope, Syncope in Athletes, Exertional Syncope, Effort Syncope, Exercise-Associated Collapse, Heat Syncope
- See Also
- Syncope
- Arrhythmias in Athletes
- Sudden Death in Athletes
- Heat Illness
- Definitions
- Exercise Related Syncope
- Loss of consciousness associated with Exercise
- History: Timing of Syncope
- Most important to distinguish timing of syncopal event
- Syncope during Exercise is ominious compared with the relatively benign post-ExerciseSyncope
- Syncope during Exercise (Exertional Syncope)
- True Syncope during Exercise is rare and should be thoroughly evaluated
- High risk for serious cause
- Consider equivalent of transient sudden death
- 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
- Symptoms
- Light headedness, Orthostasis or Dizziness immediately following Exercise
- Transient loss of consciousness
- Exam
- See Syncope
- Vital Signs (Identify Hypotension, Tachycardia)
- Thorough examination (especially cardiovascular)
- Causes: Exertional Syncope (Syncope during Exercise)
- See Arrhythmias in Athletes
- See Sudden Death in Athletes
- Cardiovascular - Arrhythmia
- Arrhythmogenic Right Ventricular Dysplasia (ARVD)
- Long QT Syndrome
- Brugada Syndrome
- Wolff-Parkinson-White Syndrome (WPW Syndrome)
- Cardiovascular - Valvular disease
- Aortic Stenosis
- Mitral Valve Prolapse
- Ebstein's Anomaly of the Tricuspid Valve
- Cardiovascular - structural
- Hypertrophic Cardiomyopathy
- Coronary Artery Disease or Coronary Artery Abnormalities
- Myocarditis
- Marfan's Syndrome
- Miscellaneous causes in athletes
- Heat Stroke
- Hypoglycemia
- Hyponatremia
- Anaphylaxis
- Precautions: Red Flags suggestive of cardiogenic Syncope
- Syncope during Exercise (see above) in contrast to the typically benign Syncope that follows Exercise
- Cardiovascular Risk Factors
- Advanced age
- Cardiac symptoms follow Syncope
- Delayed recovery
- Labs
- Bedside Glucose
- Basic chemistry panel (Serum Electrolytes)
- Complete Blood Count
- Creatinine Kinase (CPK)
- Evaluation
- See Syncope
- See Heat Illness
- Electrocardiogram
- See Electrocardiogram in Syncope
- Echocardiogram
- If indicated
- 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
- References
- Spangler and Baird in Herbert (2014) EM:Rap 14(2): 7-8
- Colivicchi (2004) Eur Heart J 25(19): 1749-53 [PubMed]