Abstract des Autors

Syncope in young persons and athletes is often harmless. But syncopal attacks, that might otherwise be innocuous under conditions of participating in certain sports involving body contact or high speed place the athlete at risk of injury or death because of transient loss of physical control. The reasons for syncope can be various neurological as well as cardiovascular diseases. In particular by patients with bradycardia or ventricular tachyarrhythmias and underlying heart diseases (e.g. QT syndrome, hypertrophic cardiomyopathy, aortic valve stenosis, WPW syndrome e.t.c.) syncope can result in sudden cardiac death. Anaphylactic reactions due to various food stuff consumption (nuts, celery, fish, wine e.t.c.), due to the intake of drugs in particular aspirin, after contact with latex, or physical exercise causing syncope must also be considered differential-diagnostically as well as psychogenic causes or hyperventilation. Neurocardiogenic (vasovagal) mechanisms are the most frequent causes of syncope in particular with highly trained athletes. The diagnostic of syncope comprises first of all a thorough case history, a physical examination and an ECG, in selected cases Holter-monitoring, exercise-testing, electrophysiology and neurological examination can help towards a diagnosis. The most important method for diagnosis and treatment of neurocardiogenic syncope is besides the typical case history (syncope after standing or sitting, in athletes also during and after heavy physical exercise) the tilt-test. There are three different forms of a positive tilt test: Vasovagal cardioinhibition with a fall in heart frequency or asystole, vasodepressor syndrome with a fall in blood pressure and mixed type as a combination of both. The majority of patients can be treated with one of the following drugs and corresponding renewed tilt control: beta-blockers, theophylline, ergotamine or disopyramide. Verf.-Referat