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Exercise-induced syncope in young athletes and risk of sudden death: clinical and genetic perspectives

González Armengol JJ, López Farré A, Prados Roa F

Servicio de Urgencias. Unidad de Investigación Cardiovascular. Hospital Clínico San Carlos. Madrid, Spain. SAMUR-Protección Civil. Ayuntamiento de Madrid, Spain.

Syncope may be a warning sign of potentially serious and even life-threatening medical
conditions. Emergency service expertise is essential for assessing risk in patients with
syncope. A focused medical history and a physical examination that includes a 12-lead
electrocardiogram (ECG) will identify the causes of syncope in half the patients. Patients
at risk are those with certain ECG abnormalities, a history of heart disease, elevated
systolic pressure, changes in breathing pattern, a fall in the hematocrit level, older age,
exercise-induced syncope, or a family history of sudden death. Structural heart disease
(congenital heart disease or primary electrical abnormalities) are the main risk factors of
sudden cardiac death (SCD) and all mortality in patients with syncope. The diagnostic
sensitivity of conventional tests remains low in these patients. SCD is normally due to
sustained tachycardia (ventricular fibrillation). The most common cause overall is
ischemic heart disease, but in patients under the age of 35 years a series of diseases have
been implicated as the most frequent causes. The past 2 years have seen studies of
genetic factors involved in cardiovascular disease that have suggested the possibility of
diagnosis for certain patients with congenital heart diseases that predispose them to
SCD. This review includes discussions of such conditions as arrhythmogenic right
ventricular dysplasia, obstructive hypertrophic cardiomyopathy, congenital long QT
syndrome, catecholaminergic ventricular tachycardia, Wolf-Parkinson-White syndrome,
or Brugada syndrome.

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