Exercise-related syncope in the young athlete: Reassurance, restriction orreferral?

A common event in young adults, syncope is usually benign and only rarely r equires more than simple reassurance. However, exercise-related syncope alw ays requires investigation because it may be the only symptom that precedes a sudden cardiac death. Syncope that occurs during exercise tends to be mo re ominous than that occurring in the postexertional state. During the phys ical examination, the cardiovascular system should be evaluated carefully. An electrocardiogram is mandatory and requires close scrutiny, with further testing ordered as indicated. The investigation of syncope should specific ally exclude known pathologic diagnoses before a complete return to activit y is permitted. In cases where a diagnosis is not clearly established, cons ultation or referral may be warranted.