Syncope associated with exercise, a manifestation of neurally mediated syncope
Abstract
A retrospective review of patients evaluated at a university-based referral hospital was performed to assess the basis for syncope associated with exercise in young patients. Over an 8-year period, 54 consecutive young patients (aged 12 to 30 years) were referred for evaluation of frank syncope. Twelve patients had syncope associated with exercise (group I) and 42 patients had syncope not associated with exercise (group II). Patients underwent physical examination, chest x-ray, 2-dimensional echocardiography, and in selected cases, cardiac catheterization. Head-up tilt-table testing was performed in 11 of 12 group I patients. Ten group I patients had no evidence of structural heart disease: 9 of these 10 (90%) developed syncope with tilt-table testing. Head-up tilt-table testing was performed in 41 of 42 group II patients: 34 (83%) developed syncope with tilt-table testing. Standard cardiac electrophysiologic study was performed in 9 of 12 group I and in 30 of 42 group II patients, and identified a basis for syncope in only 2 group I and 1 group II patients. Among 9 group I patients with a positive result on head-up tilt-table testing and no evidence of structural heart disease (mean follow-up 4.3 years), 7 are without further episodes of syncope; 3 have discontinued medication and 5 have resumed at least limited exercise. In conclusion, susceptibility to tilt-induced syncope was the most frequent finding in young patients without structural heart disease referred for evaluation of exercise-associated syncope. Tilt-table testing may be an important diagnostic tool for the evaluation of these patients.
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Syncope occurring during exercise is likely due to cardiac causes.
“Indeed, syncope occurring during exercise is likely due to cardiac causes (even though some case reports have shown that it might be a manifestation of an exaggerated reflex vasodilatation)”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [251]
Syncope occurring after exercise is almost invariably due to a reflex mechanism.
“whereas syncope occurring after exercise is almost invariably due to a reflex mechanism. 250-252”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [251]
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- Authors
- Sakaguchi, S., Shultz, J. J., Remole, S. C., Adler, S. W., Lurie, K. G., & Benditt, D. G.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Sakaguchi, Scott
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1995-03
- Volume
- 75
- Issue
- 7
- Pages
- 476-481
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2117806965
- Cited by
- 79
- References
- 21
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 1 · 2019: 2 · 2018: 6 · 2017: 1 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 5.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- neurally mediated syncope, tilt table test, young patients, structural heart disease, syncope diagnosis
- MeSH terms
- Adolescent, Adult, Child, Female, Heart Diseases, Humans, Male, Retrospective Studies, Syncope, Exercise, Tilt-Table Test
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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