Skip to main content
Top
Published in: Journal of Cardiovascular Translational Research 3/2020

01-06-2020 | Sudden Cardiac Death | Review Article

Syncope in the Young Adult and in the Athlete: Causes and Clinical Work-up to Exclude a Life-Threatening Cardiac Disease

Authors: Flavio D’Ascenzi, Alessandro Zorzi, Carlotta Sciaccaluga, Umberto Berrettini, Sergio Mondillo, Michele Brignole

Published in: Journal of Cardiovascular Translational Research | Issue 3/2020

Login to get access

Abstract

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. It is usually a benign event, but sometimes it may represent the initial presentation of several cardiac disorders associated with sudden cardiac death during physical activity. A careful evaluation is essential particularly in young adults and in competitive athletes in order to exclude the presence of an underlying life-threatening cardiovascular disease. The present review analyzes the main non-cardiac and cardiac causes of syncope and the contribution of the available tools for differential diagnosis. Clinical work-up of the athlete with syncope occurring in extreme environments and management in terms of sports eligibility and disqualification are also discussed.
Appendix
Available only for authorised users
Literature
1.
go back to reference Brignole, M., et al. (2018). 2018 ESC guidelines for the diagnosis and management of syncope. European Heart Journal, 39(21), 1883–1948.PubMed Brignole, M., et al. (2018). 2018 ESC guidelines for the diagnosis and management of syncope. European Heart Journal, 39(21), 1883–1948.PubMed
2.
go back to reference Corrado, D., et al. (2003). Does sports activity enhance the risk of sudden death in adolescents and young adults? Journal of the American College of Cardiology, 42(11), 1959–1963.PubMed Corrado, D., et al. (2003). Does sports activity enhance the risk of sudden death in adolescents and young adults? Journal of the American College of Cardiology, 42(11), 1959–1963.PubMed
3.
go back to reference Christou, G. A., Christou, K. A., & Kiortsis, D. N. (2018). Pathophysiology of noncardiac syncope in athletes. Sports Medicine, 48(7), 1561–1573.PubMed Christou, G. A., Christou, K. A., & Kiortsis, D. N. (2018). Pathophysiology of noncardiac syncope in athletes. Sports Medicine, 48(7), 1561–1573.PubMed
4.
go back to reference Colivicchi, F., Ammirati, F., & Santini, M. (2004). Epidemiology and prognostic implications of syncope in young competing athletes. European Heart Journal, 25(19), 1749–1753.PubMed Colivicchi, F., Ammirati, F., & Santini, M. (2004). Epidemiology and prognostic implications of syncope in young competing athletes. European Heart Journal, 25(19), 1749–1753.PubMed
5.
go back to reference Smith, J. J., Porth, C. M., & Erickson, M. (1994). Hemodynamic response to the upright posture. Journal of Clinical Pharmacology, 34(5), 375–386.PubMed Smith, J. J., Porth, C. M., & Erickson, M. (1994). Hemodynamic response to the upright posture. Journal of Clinical Pharmacology, 34(5), 375–386.PubMed
6.
go back to reference Christou, G. A., et al. (2016). A novel strategy for evaluating tilt test in athletes with syncope. European Journal of Preventive Cardiology, 23(9), 1003–1010.PubMed Christou, G. A., et al. (2016). A novel strategy for evaluating tilt test in athletes with syncope. European Journal of Preventive Cardiology, 23(9), 1003–1010.PubMed
7.
go back to reference Ogoh, S., et al. (2005). Dynamic cerebral autoregulation during exhaustive exercise in humans. American Journal of Physiology. Heart and Circulatory Physiology, 288(3), H1461–H1467.PubMed Ogoh, S., et al. (2005). Dynamic cerebral autoregulation during exhaustive exercise in humans. American Journal of Physiology. Heart and Circulatory Physiology, 288(3), H1461–H1467.PubMed
8.
go back to reference Willie, C. K., et al. (2013). Maintained cerebrovascular function during post-exercise hypotension. European Journal of Applied Physiology, 113(6), 1597–1604.PubMed Willie, C. K., et al. (2013). Maintained cerebrovascular function during post-exercise hypotension. European Journal of Applied Physiology, 113(6), 1597–1604.PubMed
9.
go back to reference Mundel, T., et al. (2015). Postexercise orthostatic intolerance: Influence of exercise intensity. Experimental Physiology, 100(8), 915–925.PubMed Mundel, T., et al. (2015). Postexercise orthostatic intolerance: Influence of exercise intensity. Experimental Physiology, 100(8), 915–925.PubMed
10.
go back to reference Gisolf, J., et al. (2004). Tidal volume, cardiac output and functional residual capacity determine end-tidal CO2 transient during standing up in humans. The Journal of Physiology, 554(Pt 2), 579–590.PubMed Gisolf, J., et al. (2004). Tidal volume, cardiac output and functional residual capacity determine end-tidal CO2 transient during standing up in humans. The Journal of Physiology, 554(Pt 2), 579–590.PubMed
11.
go back to reference Olshansky, B. (1999). A Pepsi challenge. The New England Journal of Medicine, 340(25), 2006.PubMed Olshansky, B. (1999). A Pepsi challenge. The New England Journal of Medicine, 340(25), 2006.PubMed
12.
go back to reference Flugelman, M., Halon, D. A., & Goldblatt, H. (1987). Golf syncope. Lancet, 2(8549), 47.PubMed Flugelman, M., Halon, D. A., & Goldblatt, H. (1987). Golf syncope. Lancet, 2(8549), 47.PubMed
13.
go back to reference Krediet, C. T., et al. (2004). Exercise related syncope, when it's not the heart. Clinical Autonomic Research, 14(Suppl 1), 25–36.PubMed Krediet, C. T., et al. (2004). Exercise related syncope, when it's not the heart. Clinical Autonomic Research, 14(Suppl 1), 25–36.PubMed
15.
go back to reference Marcus, F. I., et al. (2010). Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: Proposed modification of the Task Force Criteria. European Heart Journal, 31(7), 806–814.PubMedPubMedCentral Marcus, F. I., et al. (2010). Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: Proposed modification of the Task Force Criteria. European Heart Journal, 31(7), 806–814.PubMedPubMedCentral
16.
go back to reference D'Ascenzi, F., et al. (2018). Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete'sHeart by Using Imaging. JACC: Cardiovascular Imaging, 11(9), 1327–1339.PubMed D'Ascenzi, F., et al. (2018). Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete'sHeart by Using Imaging. JACC: Cardiovascular Imaging, 11(9), 1327–1339.PubMed
17.
go back to reference Zorzi, A., et al. (2016). Arrhythmogenic right ventricular cardiomyopathy: Risk stratification and indications for defibrillator therapy. Current Cardiology Reports, 18(6), 57.PubMed Zorzi, A., et al. (2016). Arrhythmogenic right ventricular cardiomyopathy: Risk stratification and indications for defibrillator therapy. Current Cardiology Reports, 18(6), 57.PubMed
19.
go back to reference Authors/Task Force, m, et al. (2014). 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). European Heart Journal, 35(39), 2733–2779. Authors/Task Force, m, et al. (2014). 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). European Heart Journal, 35(39), 2733–2779.
20.
go back to reference di Gioia, C. R., et al. (2016). Nonischemic left ventricular scar and cardiac sudden death in the young. Human Pathology, 58, 78–89.PubMed di Gioia, C. R., et al. (2016). Nonischemic left ventricular scar and cardiac sudden death in the young. Human Pathology, 58, 78–89.PubMed
22.
go back to reference Schnell, F., et al. (2016). Subepicardial delayed gadolinium enhancement in asymptomatic athletes: Let sleeping dogs lie? British Journal of Sports Medicine, 50(2), 111–117.PubMed Schnell, F., et al. (2016). Subepicardial delayed gadolinium enhancement in asymptomatic athletes: Let sleeping dogs lie? British Journal of Sports Medicine, 50(2), 111–117.PubMed
23.
go back to reference Cipriani, A., et al. (2019). Predictive value of exercise testing in athletes with ventricular ectopy evaluated by cardiac magnetic resonance. Heart Rhythm, 16(2), 239–248.PubMed Cipriani, A., et al. (2019). Predictive value of exercise testing in athletes with ventricular ectopy evaluated by cardiac magnetic resonance. Heart Rhythm, 16(2), 239–248.PubMed
25.
go back to reference Schwartz, P. J., Crotti, L., & Insolia, R. (2012). Long-QT syndrome: From genetics to management. Circulation. Arrhythmia and Electrophysiology, 5(4), 868–877.PubMedPubMedCentral Schwartz, P. J., Crotti, L., & Insolia, R. (2012). Long-QT syndrome: From genetics to management. Circulation. Arrhythmia and Electrophysiology, 5(4), 868–877.PubMedPubMedCentral
26.
go back to reference Priori, S. G., et al. (2016). 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Revista Española de Cardiología (English Ed), 69(2), 176. Priori, S. G., et al. (2016). 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Revista Española de Cardiología (English Ed), 69(2), 176.
27.
go back to reference Brugada, J., et al. (2018). Present status of Brugada syndrome: JACC state-of-the-art review. Journal of the American College of Cardiology, 72(9), 1046–1059.PubMed Brugada, J., et al. (2018). Present status of Brugada syndrome: JACC state-of-the-art review. Journal of the American College of Cardiology, 72(9), 1046–1059.PubMed
28.
go back to reference Pflaumer, A., & Davis, A. M. (2019). An update on the diagnosis and management of catecholaminergic polymorphic ventricular tachycardia. Heart, Lung & Circulation, 28(3), 366–369. Pflaumer, A., & Davis, A. M. (2019). An update on the diagnosis and management of catecholaminergic polymorphic ventricular tachycardia. Heart, Lung & Circulation, 28(3), 366–369.
29.
go back to reference Grani, C., et al. (2017). Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease. Journal of Nuclear Cardiology, 24(1), 226–234.PubMed Grani, C., et al. (2017). Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease. Journal of Nuclear Cardiology, 24(1), 226–234.PubMed
30.
go back to reference Basso, C., et al. (2000). Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. Journal of the American College of Cardiology, 35(6), 1493–1501.PubMed Basso, C., et al. (2000). Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. Journal of the American College of Cardiology, 35(6), 1493–1501.PubMed
31.
go back to reference Pelliccia, A., et al. (1990). Coronary arteries in physiological hypertrophy: Echocardiographic evidence of increased proximal size in elite athletes. International Journal of Sports Medicine, 11(2), 120–126.PubMed Pelliccia, A., et al. (1990). Coronary arteries in physiological hypertrophy: Echocardiographic evidence of increased proximal size in elite athletes. International Journal of Sports Medicine, 11(2), 120–126.PubMed
32.
go back to reference Zeppilli, P., et al. (1987). Echocardiographic visualization of the coronary arteries in endurance athletes. Giornale Italiano di Cardiologia, 17(11), 957–965.PubMed Zeppilli, P., et al. (1987). Echocardiographic visualization of the coronary arteries in endurance athletes. Giornale Italiano di Cardiologia, 17(11), 957–965.PubMed
33.
go back to reference Vettor, G., et al. (2015). Syncope as a warning symptom of sudden cardiac death in athletes. Cardiology Clinics, 33(3), 423–432.PubMed Vettor, G., et al. (2015). Syncope as a warning symptom of sudden cardiac death in athletes. Cardiology Clinics, 33(3), 423–432.PubMed
34.
go back to reference Zorzi, A., Cipriani, A., & Corrado, D. (2018). Circumstances of cardiac arrest during sports activity recorded on video. European Journal of Preventive Cardiology, 25(13), 1452–1454.PubMed Zorzi, A., Cipriani, A., & Corrado, D. (2018). Circumstances of cardiac arrest during sports activity recorded on video. European Journal of Preventive Cardiology, 25(13), 1452–1454.PubMed
35.
go back to reference Litovsky, S. H., & Antzelevitch, C. (1990). Differences in the electrophysiological response of canine ventricular subendocardium and subepicardium to acetylcholine and isoproterenol. A direct effect of acetylcholine in ventricular myocardium. Circulation Research, 67(3), 615–627.PubMed Litovsky, S. H., & Antzelevitch, C. (1990). Differences in the electrophysiological response of canine ventricular subendocardium and subepicardium to acetylcholine and isoproterenol. A direct effect of acetylcholine in ventricular myocardium. Circulation Research, 67(3), 615–627.PubMed
36.
go back to reference Corrado, D., et al. (2006). Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA, 296(13), 1593–1601.PubMed Corrado, D., et al. (2006). Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA, 296(13), 1593–1601.PubMed
37.
go back to reference Sharma, S., et al. (2018). International recommendations for electrocardiographic interpretation in athletes. European Heart Journal, 39(16), 1466–1480.PubMed Sharma, S., et al. (2018). International recommendations for electrocardiographic interpretation in athletes. European Heart Journal, 39(16), 1466–1480.PubMed
38.
go back to reference Maron, B. J., et al. (2009). Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980-2006. Circulation, 119(8), 1085–1092.PubMed Maron, B. J., et al. (2009). Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980-2006. Circulation, 119(8), 1085–1092.PubMed
39.
go back to reference D'Ascenzi, F., et al. (2015). Exercise-induced left-ventricular hypertrabeculation in athlete's heart. International Journal of Cardiology, 181, 320–322.PubMed D'Ascenzi, F., et al. (2015). Exercise-induced left-ventricular hypertrabeculation in athlete's heart. International Journal of Cardiology, 181, 320–322.PubMed
40.
go back to reference Pelliccia, A., et al. (2018). European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. European Heart Journal, 39(21), 1949–1969.PubMed Pelliccia, A., et al. (2018). European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. European Heart Journal, 39(21), 1949–1969.PubMed
41.
go back to reference Palmieri, V., et al. (2018). Anomalous origin of coronary arteries from the "wrong" sinus in athletes: Diagnosis and management strategies. International Journal of Cardiology, 252, 13–20.PubMed Palmieri, V., et al. (2018). Anomalous origin of coronary arteries from the "wrong" sinus in athletes: Diagnosis and management strategies. International Journal of Cardiology, 252, 13–20.PubMed
42.
go back to reference Pelliccia, A., Spataro, A., & Maron, B. J. (1993). Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. The American Journal of Cardiology, 72(12), 978–979.PubMed Pelliccia, A., Spataro, A., & Maron, B. J. (1993). Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. The American Journal of Cardiology, 72(12), 978–979.PubMed
43.
go back to reference Shen, W. K., et al. (2017). 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 70(5), 620–663.PubMed Shen, W. K., et al. (2017). 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 70(5), 620–663.PubMed
44.
go back to reference Zipes, D. P., et al. (2005). Task Force 7: Arrhythmias. Journal of the American College of Cardiology, 45(8), 1354–1363.PubMed Zipes, D. P., et al. (2005). Task Force 7: Arrhythmias. Journal of the American College of Cardiology, 45(8), 1354–1363.PubMed
45.
go back to reference Sirico, F., et al. (2019). Exercise stress test in apparently healthy individuals - where to place the finish line? The Ferrari corporate wellness programme experience. European Journal of Preventive Cardiology, 26(7), 731–738.PubMed Sirico, F., et al. (2019). Exercise stress test in apparently healthy individuals - where to place the finish line? The Ferrari corporate wellness programme experience. European Journal of Preventive Cardiology, 26(7), 731–738.PubMed
46.
go back to reference D'Ascenzi, F., et al. (2017). The prevalence and clinical significance of premature ventricular beats in the athlete. Scandinavian Journal of Medicine & Science in Sports, 27(2), 140–151. D'Ascenzi, F., et al. (2017). The prevalence and clinical significance of premature ventricular beats in the athlete. Scandinavian Journal of Medicine & Science in Sports, 27(2), 140–151.
47.
go back to reference van Dijk, N., et al. (2008). High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: The fainting assessment study. Journal of Cardiovascular Electrophysiology, 19(1), 48–55.PubMed van Dijk, N., et al. (2008). High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: The fainting assessment study. Journal of Cardiovascular Electrophysiology, 19(1), 48–55.PubMed
48.
go back to reference Brignole, M., et al. (2006). A new management of syncope: Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. European Heart Journal, 27(1), 76–82.PubMed Brignole, M., et al. (2006). A new management of syncope: Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. European Heart Journal, 27(1), 76–82.PubMed
49.
go back to reference Sivakumaran, S., et al. (2003). A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. The American Journal of Medicine, 115(1), 1–5.PubMed Sivakumaran, S., et al. (2003). A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. The American Journal of Medicine, 115(1), 1–5.PubMed
50.
go back to reference Ruwald, M. H., & Zareba, W. (2013). ECG monitoring in syncope. Progress in Cardiovascular Diseases, 56(2), 203–210.PubMed Ruwald, M. H., & Zareba, W. (2013). ECG monitoring in syncope. Progress in Cardiovascular Diseases, 56(2), 203–210.PubMed
51.
go back to reference Brignole, M., et al. (2006). Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope. European Heart Journal, 27(18), 2232–2239.PubMed Brignole, M., et al. (2006). Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope. European Heart Journal, 27(18), 2232–2239.PubMed
52.
go back to reference Deharo, J. C., et al. (2006). An implantable loop recorder study of highly symptomatic vasovagal patients: The heart rhythm observed during a spontaneous syncope is identical to the recurrent syncope but not correlated with the head-up tilt test or adenosine triphosphate test. Journal of the American College of Cardiology, 47(3), 587–593.PubMed Deharo, J. C., et al. (2006). An implantable loop recorder study of highly symptomatic vasovagal patients: The heart rhythm observed during a spontaneous syncope is identical to the recurrent syncope but not correlated with the head-up tilt test or adenosine triphosphate test. Journal of the American College of Cardiology, 47(3), 587–593.PubMed
53.
go back to reference Maines, M., et al. (2018). Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic reveal LINQTM. Europace, 20(6), 1050–1057.PubMed Maines, M., et al. (2018). Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic reveal LINQTM. Europace, 20(6), 1050–1057.PubMed
54.
go back to reference Stein, K. M., et al. (2001). Formal analysis of the optimal duration of tilt testing for the diagnosis of neurally mediated syncope. American Heart Journal, 141(2), 282–288.PubMed Stein, K. M., et al. (2001). Formal analysis of the optimal duration of tilt testing for the diagnosis of neurally mediated syncope. American Heart Journal, 141(2), 282–288.PubMed
55.
go back to reference Kapoor, W. N., Smith, M. A., & Miller, N. L. (1994). Upright tilt testing in evaluating syncope: A comprehensive literature review. The American Journal of Medicine, 97(1), 78–88.PubMed Kapoor, W. N., Smith, M. A., & Miller, N. L. (1994). Upright tilt testing in evaluating syncope: A comprehensive literature review. The American Journal of Medicine, 97(1), 78–88.PubMed
56.
go back to reference Hastings, J. L., & Levine, B. D. (2012). Syncope in the athletic patient. Progress in Cardiovascular Diseases, 54(5), 438–444.PubMed Hastings, J. L., & Levine, B. D. (2012). Syncope in the athletic patient. Progress in Cardiovascular Diseases, 54(5), 438–444.PubMed
57.
go back to reference Gati, S., Sharma, S., & Pennell, D. (2018). The role of cardiovascular magnetic resonance imaging in the assessment of highly trained athletes. JACC: Cardiovascular Imaging, 11(2 Pt 1), 247–259.PubMed Gati, S., Sharma, S., & Pennell, D. (2018). The role of cardiovascular magnetic resonance imaging in the assessment of highly trained athletes. JACC: Cardiovascular Imaging, 11(2 Pt 1), 247–259.PubMed
58.
go back to reference Nucifora, G., et al. (2014). Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin: A magnetic resonance imaging study. Circulation. Arrhythmia and Electrophysiology, 7(3), 456–462.PubMed Nucifora, G., et al. (2014). Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin: A magnetic resonance imaging study. Circulation. Arrhythmia and Electrophysiology, 7(3), 456–462.PubMed
59.
go back to reference Andreini, D., et al. (2019). CMR for identifying the substrate of ventricular arrhythmia in patients with Normal echocardiography. JACC: Cardiovascular Imaging, 13(2 Pt 1), 410–421. Andreini, D., et al. (2019). CMR for identifying the substrate of ventricular arrhythmia in patients with Normal echocardiography. JACC: Cardiovascular Imaging, 13(2 Pt 1), 410–421.
61.
go back to reference Habib, M., Hoss, S., & Rakowski, H. (2019). Evaluation of hypertrophic cardiomyopathy: Newer Echo and MRI approaches. Current Cardiology Reports, 21(8), 75.PubMed Habib, M., Hoss, S., & Rakowski, H. (2019). Evaluation of hypertrophic cardiomyopathy: Newer Echo and MRI approaches. Current Cardiology Reports, 21(8), 75.PubMed
62.
go back to reference Fattori, R., et al. (2010). Significance of magnetic resonance imaging in apical hypertrophic cardiomyopathy. The American Journal of Cardiology, 105(11), 1592–1596.PubMed Fattori, R., et al. (2010). Significance of magnetic resonance imaging in apical hypertrophic cardiomyopathy. The American Journal of Cardiology, 105(11), 1592–1596.PubMed
63.
go back to reference Task Force, M., et al. (2013). 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal, 34(38), 2949–3003. Task Force, M., et al. (2013). 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal, 34(38), 2949–3003.
64.
go back to reference Berrettini, U., Trivelloni, P., & Patteri, G. (2010). Syncope in the hyperbaric environment. Giornale Italiano di Cardiologia (Rome), 11(10 Suppl 1), 122S–125S. Berrettini, U., Trivelloni, P., & Patteri, G. (2010). Syncope in the hyperbaric environment. Giornale Italiano di Cardiologia (Rome), 11(10 Suppl 1), 122S–125S.
65.
go back to reference Craig Jr., A. B. (1961). Causes of loss of consciousness during underwater swimming. Journal of Applied Physiology, 16, 583–586.PubMed Craig Jr., A. B. (1961). Causes of loss of consciousness during underwater swimming. Journal of Applied Physiology, 16, 583–586.PubMed
66.
go back to reference Hong, S. K., et al. (1963). Diving pattern, lung volumes, and alveolar gas of the Korean diving woman (ama). Journal of Applied Physiology (Bethesda, MD: 1985), 18(3), 457–465. Hong, S. K., et al. (1963). Diving pattern, lung volumes, and alveolar gas of the Korean diving woman (ama). Journal of Applied Physiology (Bethesda, MD: 1985), 18(3), 457–465.
67.
go back to reference Joulia, F., et al. (2013). Plasma adenosine release is associated with bradycardia and transient loss of consciousness during experimental breath-hold diving. International Journal of Cardiology, 168(5), e138–e141.PubMed Joulia, F., et al. (2013). Plasma adenosine release is associated with bradycardia and transient loss of consciousness during experimental breath-hold diving. International Journal of Cardiology, 168(5), e138–e141.PubMed
68.
go back to reference Berrettini, U., Landolfi, A., & Patteri, G. (2008). The heart in extreme sports: hyperbaric activity and microgravity. Giornale Italiano di Cardiologia (Rome), 9(10 Suppl 1), 94S–98S. Berrettini, U., Landolfi, A., & Patteri, G. (2008). The heart in extreme sports: hyperbaric activity and microgravity. Giornale Italiano di Cardiologia (Rome), 9(10 Suppl 1), 94S–98S.
Metadata
Title
Syncope in the Young Adult and in the Athlete: Causes and Clinical Work-up to Exclude a Life-Threatening Cardiac Disease
Authors
Flavio D’Ascenzi
Alessandro Zorzi
Carlotta Sciaccaluga
Umberto Berrettini
Sergio Mondillo
Michele Brignole
Publication date
01-06-2020
Publisher
Springer US
Published in
Journal of Cardiovascular Translational Research / Issue 3/2020
Print ISSN: 1937-5387
Electronic ISSN: 1937-5395
DOI
https://doi.org/10.1007/s12265-020-09989-0

Other articles of this Issue 3/2020

Journal of Cardiovascular Translational Research 3/2020 Go to the issue