Exercise-associated collapse: an evidence-based review and primer for clinicians

Abstract

Exercise-associated collapse (EAC) commonly occurs after the completion of endurance running events. EAC is a collapse in conscious athletes who are unable to stand or walk unaided as a result of light headedness, faintness and dizziness or syncope causing a collapse that occurs after completion of an exertional event. Although EAC is perhaps the most common aetiology confronted by the medical provider attending to collapsed athletes in a fi nish-line tent, providers must fi rst maintain vigilance for other potential life-threatening aetiologies that cause collapse, such as cardiac arrest, exertional heat stroke or exercise-associated hyponatraemia. Previously, it has been believed that dehydration and hyperthermia were primary causes of EAC. On review of the evidence, EAC is now believed to be principally the result of transient postural hypotension caused by lower extremity pooling of blood once the athlete stops running and the resultant impairment of cardiac barorefl exes. Once life-threatening aetiologies are ruled out, treatment of EAC is symptomatic and involves oral hydration and a Trendelenburg positiontotal body cooling, intravenous hydration or advanced therapies is generally not needed.

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…However, syncope during exercise is a much more compelling symptom and can be a harbinger of SCD. 712,713 Syncopal episodes first require a personal and family history to evaluate precipitating causes and benign conditions, particularly volume depletion and vasovagal activity. Concomitant illnesses, especially viral infections, should be investigated and an ECG obtained.…”

Biomarker Changes after Strenuous Exercise Can Mimic Pulmonary Embolism and Cardiac Injury—A Metaanalysis of 45 Studies

“…However, strenuous exercise has also been shown to cause notable perturbation in blood chemistry (1 ). It is estimated that 25 out of every 1000 marathon runners seek medical care after competition (2 ). Exercise-associated collapse (EAC) 5 is, with rates of 59%-85%, the most common cause seen in the medical tent after prolonged endurance exercise (3 ).…”

Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete

“…[20][21][22] It is common in marathons, (59%-69% of all medical encounters at the finish line), resulting in 10.1 to 13.7 medical illnesses per 1000 runners. 23 EAC is less common during ultramarathons, representing 6.6% of all medical encounters during a multistage ultramarathon.…”