How to Manage Athletes with Syncope
Section snippets
Incidence
In the general population, syncope is seen in up to 40% over a lifetime. The authors have had little information on the incidence in the athlete until recently, when data from the Italian screening programs have become available. In this recent series, Colivicchi and colleagues reported on 7568 athletes screened for athletic participation [7]. In these, 474 (6.2%) reported a syncopal spell in the preceding 5 years. Syncope was unrelated to exercise in 87.7%, postexertional in 12.0%, and
Risks of exercise
Although the long-term benefit of exercise has been shown to decrease the mortality of a number of diseases, this beneficial effect does not come without some acute risk. A number of investigators have shown that there is an increased risk of sudden death in athletes with underlying cardiovascular disease, including the young [8], [9], [10], [11]. During exercise, mechanisms for the increased risk of sudden death include plaque rupture, caused by shear stress, and subsequent coronary
Workup of the athlete with syncope
The athlete with syncope presents a unique challenge to the physician. Syncope in young individuals is usually benign; however, syncope can be a warning of impending SCD, especially in those with diagnosed or undiagnosed heart disease [14], [15], [16], [17]. The etiology of syncope in these young healthy individuals ranges from benign neurocardiogenic syncope to nonsustained life-threatening arrhythmias. In these individuals, in whom most will have benign causes of syncope, it is critically
Neurally mediated syncope
Neurocardiogenic syncope is the most common cause of syncope in the young individual. This disorder is characterized by occurring during upright posture, frequent situational triggers, and premonitory symptoms of warmth, lightheadedness, palpitations, sweating, and pallor. Loss of consciousness occurs over 5 to 10 seconds, often causing āslumping,ā although some episodes may be quite abrupt. Patients typically regain consciousness rapidly, but feelings of fatigue continue. More recently, it has
Summary
Athletes with syncope warrant a full evaluation. These athletes may suffer from neurocardiogenic syncope, the most common cause of syncope in the young. In this case their prognosis is excellent and they can continue to compete. However, it is also possible that athletics may unmask heart disease, either structural or electrical, and these athletes may be at risk of sudden cardiac death. The workup and treatment of syncope in the athlete offers some unique challenges: to diagnose potentially
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