Syncope in an Athlete With Apical Hypertrophic Cardiomyopathy: Ominous or Orthostatic?

Syncope in athletes with hypertrophic cardiomyopathy (HCM) requires careful evaluation, as etiologies range from benign to life-threatening. Guidelines emphasize individualized risk stratification and shared decision-making.

A 20-year-old basketball player experienced a syncopal episode when rising from a seated position, preceded by progressive lightheadedness and visual dimming, without chest discomfort or palpitations. Electrocardiogram abnormalities prompted further imaging, confirming the diagnosis of apical HCM. Evaluation demonstrated no left ventricular outflow tract obstruction at rest or with maximal-effort stress testing, and no exertional arrhythmias were observed. The episode was attributed to orthostatic syncope in a preload-dependent structurally abnormal left ventricle. He continued sports participation with hydration counseling, annual imaging, rhythm monitoring, and genetic evaluation, without recurrent events.

This case highlights the importance of accurately identifying the etiology of syncope in athletes with HCM and supports individualized, risk informed sport participation rather than universal restriction.

Syncope in athletes with HCM warrants comprehensive evaluation and tailored return-to-play decisions.