Practical management: a systematic approach to the evaluation of exercise-related syncope in athletes

Syncope and presyncope are relatively common presentations among athletes. The distinction between post-exercise and during-exercise syncope is critically important. While the great majority of these episodes occur just after exercise and are benign, syncope can be an indication of serious underlying cardiovascular disease if it occurs during exercise. Syncope presents a challenging differential diagnosis, as well as a daunting array of diagnostic tests and advanced imaging strategies. Sequencing a proper evaluation, and deciding who requires consultation and restriction, can be difficult for the medical provider. We present a systematic approach that assists the sports physician in arriving at a diagnosis and organizing an initial management strategy.