Tilt table testing in the evaluation and management of athletes with recurrent exercise-induced syncope

Recommendations for Competitive Sports Participation in Athletes With Cardiovascular Disease: A Consensus Document From the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

“…In young athletes, syncope is most often neurocardiogenic and seems to have a fair prognosis. 92,93 Evaluation of athletes with syncope should differentiate true syncope from other conditions causing loss of consciousness (epilepsy, transitory ischaemic attack, drop attack, hypoglycaemia), and assess the presence of cardiac disease. Initial evaluation includes history (aimed at a clear description of the syncope), physical examination with BP measurement in the recumbent and standing positions, and ECG.…”

“…The 24 h Holter monitoring is necessary in case of suspicion of an arrhythmic cause of the syncope; exercise testing is indicated if syncope is related to exercise, as well as in subjects with suspected IHD. 92 The head-up tilt test is needed to confirm the neurocardiogenic origin of the syncope (although this test has lower specificity in athletes compared with the general population 93 ). An electrophysiologic study is indicated when syncope is associated with palpitations as the likely expression of paroxysmal tachycardia.…”

Water drinking as a potential treatment for idiopathic exercise-related syncope

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Exercise-related syncope without organic heart disease has frequently been reported in young athletes [2,5,[9][10][11]14]. The exact incidence of idiopathic exercise-related syncope among young athletes is not known.

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“…Calkins et al and Colivicchi et al found that after a thorough cardiac evaluation athletes with an exertional-related syncope could safely continue to participate in athletics [2,3]. Tilt-table testing may be a useful diagnostic tool provoking syncope in 41 % of 24 athletes and up to 79 % after isoproterenol infusion [5]. Idiopathic exercise-related syncope has been reported to result from hypotension together with a normal HR, tachycardia, bradycardia or asystole [2,9].…”

“…The pathophysiology of this condition is poorly understood [9]. Atenolol, hydrofludrocortisone, disopyramide, transdermal scopolamine and increased salt intake have been recommended as treatment for exercise-related syncope [2,5,10,11,13]. To our knowledge this is the first report of a beneficial effect of water drinking for this condition.…”