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Syncope/Presyncope in the Competitive Athlete

  • Chad A. Asplund
  • Francis G. O’Connor
  • Benjamin D. Levine
Chapter

Abstract

Syncope is a relatively common event in the general population and is not infrequently encountered in athletes. The pathophysiology of all forms of syncope consists of a sudden decrease in cerebral blood flow, though there are many other mechanisms for transient loss of consciousness (TLOC).

Keywords

Aortic Stenosis Hypertrophic Cardiomyopathy Structural Heart Disease Young Athlete Orthostatic Intolerance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Maron BJ. Cardiovascular risks to the young person on the athletic field. Ann Int Med 1998; 129(5): 379–386.PubMedGoogle Scholar
  2. 2.
    Ananthasubramaniam K, Khaja F. Arrhythmogenic right ventricular dysplasia /cardiomyopathy: review for the clinician. Prog Cardiovasc Dis 1998; 41: 237–246.CrossRefPubMedGoogle Scholar
  3. 3.
    Eckart RE, Scoville SL, Campbell CL, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004; 141: 829–834.PubMedGoogle Scholar
  4. 4.
    Maron, BJ. Sudden death in young athletes. N Engl J Med 2003; 349: 1064–1075.CrossRefPubMedGoogle Scholar
  5. 5.
    Kapoor W. Syncope. N Engl J Med 2000; 343(25): 1856–1862.CrossRefPubMedGoogle Scholar
  6. 6.
    Thijs RD, Wieling W, Kaufmann H, et al. Defining and classifying syncope. Clin Auton Res 2004; 14(S1): 4–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation 2007; 115: 1643–1655.CrossRefPubMedGoogle Scholar
  8. 8.
    Mitchell JH, Haskell W, Snell P, et al. Task Force 8: classification of sports. 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005; 45: 1364–1367.CrossRefPubMedGoogle Scholar
  9. 9.
    Roberts WO. Exercise-associated collapse in endurance events. A classification system. Phys Sportsmed 1989; 17: 49–57.Google Scholar
  10. 10.
    Strickberger SA, Benson DW, Biaggioni I, et al. AHA /ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Circulation 2006; 113: 316 –327.CrossRefPubMedGoogle Scholar
  11. 11.
    Sarasin FP, Louis-Simonet M, Carballo D, et al. Prospective evaluation of patients with syncope. Am J Med 2001; 111: 177–184.CrossRefPubMedGoogle Scholar
  12. 12.
    Colivicchi F, Ammirati F, Santini M, et al. Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J 2004; 25: 1749 –1753.CrossRefPubMedGoogle Scholar
  13. 13.
    Alboni P, Brignole M, Menozzi C et al. The diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001; 37: 1921–1928.CrossRefPubMedGoogle Scholar
  14. 14.
    Driscoll DJ, Jacobsen SJ, Porter CJ, et al. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29(5): 1039 –1045.CrossRefPubMedGoogle Scholar
  15. 15.
    Holtzhausen L, Noakes TD, Kroning B, et al. Clinical and biochemical characteristics of collapsed ultramarathon runners. Med Sci Sports Exerc 1994; 26: 1095 –1101.PubMedGoogle Scholar
  16. 16.
    Levine BD. VO2max: What do we know, and what do we still need to know? J Physiol 2008; 586.1: 25–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Levine BD, Lane LD, Buckey JC Jr, et al. Left ventricular pressure-volume and Frank-Starling relations in endurance athletes: implication for orthostatic tolerance and exercise performance. Circulation 1991; 84: 1016–1023.CrossRefPubMedGoogle Scholar
  18. 18.
    Levine BD, Buckey JC, Fritsch JM, et al. Physical fitness and cardiovascular regulation: mechanisms of orthostatic intolerance. J Appl Physiol 1991; 70: 112–122.PubMedGoogle Scholar
  19. 19.
    Corrado D, Basso C, Schiavon M et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998; 339: 364–369.CrossRefPubMedGoogle Scholar
  20. 20.
    Marcus FI, Fontaine GH, Guiraudon G, et al. Right ventricular dysplasia: a report of 24 adult cases. Circulation 1982; 65: 384–398.CrossRefPubMedGoogle Scholar
  21. 21.
    Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace 2004; 6: 467–537.CrossRefPubMedGoogle Scholar
  22. 22.
    Linzer M, Pritchett ELC, Pontinen M, et al. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am J Cardiol 1990; 66: 214–219.CrossRefPubMedGoogle Scholar
  23. 23.
    Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with qt prolongation and ephedra-free xenadrine. Mayo Clin Proc 2004; 79(8): 1059–1062.CrossRefPubMedGoogle Scholar
  24. 24.
    McAward KJ, Moriarty JM. Exertional syncope and presyncope. Phys Sportsmed 2005; 33: 7–20, 41.CrossRefPubMedGoogle Scholar
  25. 25.
    Ing FF, Stare TJ, Griffiths SP, et al. Early diagnosis of coarctation of the aorta in children: a continuing dilemma. Pediatrics 1996; 98(3): 378–382.PubMedGoogle Scholar
  26. 26.
    Pellicia A, Maron BJ, Cuasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278–284.CrossRefGoogle Scholar
  27. 27.
    Zehender M, Meinertz T, Keul J, et al. ECG variants and cardiac arrythmias in athletes: clinical relevance and prognostic importance. Am Heart J 1990; 119: 1378–1391.CrossRefPubMedGoogle Scholar
  28. 28.
    Ritter S, Tani LY, Etheridge SP, et al. What is the yield of screening echocardiography in pediatric syncope? Pediatrics 2000; 105(5): e58.CrossRefPubMedGoogle Scholar
  29. 29.
    Recchia D, Barzilai B. Echocardiography in the evaluation of patients with syncope. J Gen Intern Med 1995; 10: 649–655.CrossRefPubMedGoogle Scholar
  30. 30.
    Linzer M, Yang EH, Estes NA, et al. Diagnosing syncope. Part 1: value of history, physical examination, and electrocardiography. Clinical efficacy assessment project of the American College of Physicians. Ann Intern Med 1997; 126(12): 989–996.PubMedGoogle Scholar
  31. 31.
    Bass EB, Curtiss EI, Arena VC, et al. The duration of Holter monitoring in patients with syncope: is 24 hours enough? Arch Intern Med 1990; 150: 1073–1078.CrossRefPubMedGoogle Scholar
  32. 32.
    Krahn AD, Klein GJ, Yee R, et al. Use of an extended monitoring strategy in patients with problematic syncope. Circulation 1999; 99: 406 – 410.CrossRefPubMedGoogle Scholar
  33. 33.
    Kosinski D, Brubb BP, Karas BJ, et al. Clinical data, pathophysiological aspects, and potential role of tilt table testing. Europace 2000; 2: 77–82.CrossRefPubMedGoogle Scholar
  34. 34.
    Grubb BP, Temesy-Armos PN, Samoil D, et al. Tilt table testing in the evaluation and management of athletes with recurrent exercise induced syncope. Med Sci Sports Exerc 1993; 25(1): 24–28.CrossRefPubMedGoogle Scholar
  35. 35.
    Raven PB, Pawelczyk JA. Chronic endurance exercise training: a condition of inadequate blood pressure regulation and reduced tolerance to LBNP: Symposium. Med Sci Sports Exerc 1993; 25(6): 713–721.PubMedGoogle Scholar
  36. 36.
    Johnson WO. Heart of the matter. Sports Illus 1993; 24: 36–41.Google Scholar
  37. 37.
    Linzer M, Yang EH, Estes NA, et al. Diagnosing syncope. Part 2: unexplained syncope. Clinical efficacy assessment project of the American College of Physicians. Ann Intern Med 1997; 127(1): 76–86.PubMedGoogle Scholar
  38. 38.
    Fujimura O, Yee R, Klein GJ, et al. The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. N Engl J Med 1989; 321: 1703–1707.CrossRefPubMedGoogle Scholar
  39. 39.
    O’Connor FG, Oriscello RG, Levine BD. Exercise-related syncope in the young athlete: reassurance, restriction or referral? Am Fam Physician 1999; 60(7): 2001–2008.PubMedGoogle Scholar
  40. 40.
    Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol 2005; 45: 1318–1321.CrossRefPubMedGoogle Scholar
  41. 41.
    American Academy of Pediatrics Committee on Sports Medicine and Fitness. Cardiac dysrhythmias and sports. Pediatrics 1995; 95: 786–788.Google Scholar
  42. 42.
    Calkins H, Seifert M, Morady F. Clinical presentation and long-term follow-up of athletes with exercise-induced vasodepressor syncope. Am Heart J 1995; 129: 1159–1164.CrossRefPubMedGoogle Scholar
  43. 43.
    Paterick TE, Paterick TJ, Fletcher GF, et al. Medical and legal issues in the cardiovascular evaluation of competitive athletes. JAMA 2005; 294: 3011–308.CrossRefPubMedGoogle Scholar
  44. 44.
    Levine BD, Stray-Gundersen J. The medical care of competitive athletes: the role of the physician and individual assumption of risk. Med Sci Sports Exerc 1994; 26: 1190–1192.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Chad A. Asplund
    • 1
  • Francis G. O’Connor
  • Benjamin D. Levine
  1. 1.Primary Care Sports Medicine, Department of Family MedicineEisenhower Army Medical CenterFort GordonUSA

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