Exercise Associated Collapse
- Exercise-Associated Collapse
- Exercise associated collapse (EAC) is defined as a collapse in conscious athletes who are unable to stand or walk unaided as a result of lightheadedness, faintness and dizziness or syncope causing a collapse that occurs after completion of an exertional event
- Important to distinguish from other, more serious causes of collapse
- Up to 25 of every 1000 marathon participants seeks post race medical attention
- However this is highly dependent on environmental conditions
- The Gothenburg half marathon, the worlds largest, reports an incidence of 1.53 per 1000 runners
- They also reported a 2:1 male to female treatment ratio
- EAC represents the most common condition to seek medical attention
- 59-85% of visits after marathons and ultramarathons
- Incidence of EAC appears to increase as the race distance, temperature, and humidity increase
- Due primarily to pooling of blood in lower extremities once athlete stops running
- Lower extremities require increased blood flow during exercise, resulting in a decrease in peripheral vascular resistance
- Upon cessation of activity, the legs no longer assist in venous return and large volumes of blood pool in the lower extremities
- This is sometimes termed orthostatic intolerance (OI)
- Studies support increased susceptibility to in exercise-trained athletes
- Increase in lower extremity compliance, increased diastolic chamber compliance, distensibility contribute to OI
- Trained athletes have increased vascular volume and stroke volume
- The baroreflex, responsible for maintaining blood pressure, is impaired due to this increase in volume
- Thus endurance athletes are more dependent on venous return, especially when upright and following exercise
- Heat stress, increased skin temperature do contribute to OI
- It may also impair the aforementioned baroreflex
- Currently no compelling evidence to support dehydration as contributor to OI and EAC
- Increased distance
- Increased temperature
- Increased humidity
- Endurance events
- Cardiac Arrest
- Exercise Induced Anaphylaxis
- Exercise Associated Hyponatremia
- Exertional Heat Stroke
- Heat Exhaustion
- Acute Mountain Sickness
- High Altitude Cerebral Edema
- High Altitude Pulmonary Edema
- Exercise Associated Postural Hypotension
- Witnessed collapse
- The athlete will likely endorse lightheadedness, faintness and dizziness or syncope
- Physical Exam
- Patient should be lucid, full conscious and A+Ox3
- Often HR >100, BP <100
- Primarily a clinical diagnosis
- Exclude hyperthermia related causes by checking vital signs including core temperature and weight
- Exclude hyponatremia by checking point of care blood gas or electrolytes
- Serum glucose should be checked
- Exercise Associated Postural Hypotension (EAPH) can present similarly
- Distinguished from this entity by having no change in blood pressure from supine to standing position
- The most important thing in collapsed athletes is to exclude other, life threatening etiologies
- Vital signs and point of care electrolytes, glucose should be checked
- Treatment directed at prevention of pooling of blood in lower extremities
- The easiest treatment is to have post-activity athletes continue walking and not stop and stand in one position
- Oral hydration is preventative and therapeutic
- Trendelenberg can promote restoration of normal hemodynamics
- Peripheral skin cooling may increase peripheral vascular resistance, decrease cardiovascular strain and improve OI
- Conservative therapy should lead to recovery in 60-90 minutes
- Individuals prone to OI
- consider wearing compression stockings while running
- Can also consider Antihistamine medications
- Hyperthermia and dehydration are not considered primary etiologies of EAC
- Total body cooling and IV fluids should be avoided
Rehab and Return to Play
- Needs to be updated
Return to Play
- Needs to be updated
- The most feared complication is missing other causes of collapse
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