Exercise Induced Syncope

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

advertisement

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
  4. Heat Syncope
    1. See Heat Illness
    2. See Heat Illness Risk Factors (includes Sickle Cell Trait)
    3. Dizziness or fainting with heat exposure immediately after completing Exercise or with prolonged standing
    4. Secondary to peripheral vasodilatation and venous pooling with secondary Postural Hypotension
    5. Seen in persons unaccustomed to extreme heat
    6. Consider Syncope differential diagnosis
      1. Exertional Syncope during Exercise is concerning (where as Syncope after Exercise is typically benign)
      2. Hypoglycemia
      3. Hyponatremia

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. Position patient supine with legs elevated
    2. Encourage oral hydration
    3. Anticipate symptom resolution in 15-20 minutes
  2. Additional measures in Heat Related Illness
    1. See Heat Illness
    2. Move to cool, shaded environment, lie supine, and administer oral rehydration with salt containing solutions
    3. Initiate external cooling if concern for Heat Exhaustion or Heat Stroke
  3. Reassuring findings consistent with discharge home
    1. Rapid recovery within 15 minutes
    2. Normalization of Vital Signs
    3. Ambulating well without recurrent symptoms
  4. Further urgent or emergent evaluation needed
    1. Prolonged recovery time >15 minutes
    2. Loss of consciousness durin Exercise
    3. Preceding cardiac symptoms (Chest Pain, Palpitations, Shortness of Breath)
    4. Cardiovascular Risk Factors
  5. 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]
  3. Gauer (2026) Am Fam Physician 113(4): 369-81 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Exercise Induced Syncope." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Symptoms

advertisement