Syncopes in adolescents in sport

Abstract

The study analyzes current data on syncope in children and adolescents. The study presents the classification of syncope and briefly describes the clinical manifestations of neurally mediated syncope and the main methods of its diagnosis and treatment. Syncopes associated with organic cardiac pathologies and primary cardiac arrhythmias are caused by hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, coronary artery anomalies, primary long QT syndrome, Wolff–Parkinson–White syndrome, and bradyarrhythmias. The diagnostic features of syncope in children and young athletes and modern approaches to treatment and prevention are discussed.

Although most syncopes in athletes are not associated with physical activity and have a neurotransmitter genesis, a thorough medical examination is needed. Factors that induce the development of syncopes in athletes must be identified. A prerequisite for admission to sports is the exclusion of the cardiac and arrhythmogenic reasons of syncopes. The decision to expand the sports regime should be made only after a thorough collection of medical history, including family history, and a comprehensive examination. In addition, the degree of risk in view of injuries, provocation, or fatal events following the loss of consciousness during sports must be estimated. This is extremely relevant for sports such as swimming, complex coordination sports (gymnastics and acrobatics), auto and motor sports, and alpine skiing.

Although syncopes are common problems in pediatric practice, with only a few cases with cardiac causes based on structural or primary electrical myocardial diseases, they pose the greatest danger in sports medicine. Thus, such conditions must be excluded in young athletes because sports load can aggravate cardiac pathologies, which cause syncopes, due to untimely diagnosis before the start of a sports career.

Keywords

syncope / athletes / children / adolescents

References

[1] Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. Circulation. 2017;5(136):e60–e122. doi: 10.1161/CIR.0000000000000499 Erratum in: Circulation. 2017;136(16):e271–e272.

[2] Shen W.K., Sheldon R.S., Benditt D.G., et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society // Circulation. 2017. Vol. 136, N 16. P. e60–e122. doi: 10.1161/CIR.0000000000000499 Erratum in: Circulation. 2017. Vol. 136, N 16. P. e271–e272.

[3] Tereshchenko SYu. Cardiogenic syncopal states in children and adolescents. Current Pediatrics (Moscow). 2011;10(2):64–70. (In Russ).

[4] Терещенко С.Ю. Кардиогенные синкопальные состояния у детей и подростков // Вопросы современной педиатрии. 2011. Т. 10, № 2. С. 64–70.

[5] Chen L, Wang C, Wang H, et al. Underlying diseases in syncope of children in China. Med Sci Monit. 2011;17(6): PH49–PH53. doi: 10.12659/msm.881795

[6] Chen L., Wang C., Wang H., et al. Underlying diseases in syncope of children in China // Med Sci Monit. 2011. Т. 17, N 6. P. PH49–PH53. doi: 10.12659/msm.881795

[7] Makarov LM, Komolyatova VN, Kiseleva II, et al. Epidemiology of the syncope in children and adolescents in elite sport (EPISODE-S research). Russian Bulletin of Perinatology and Pediatrics. 2019;64(6):62–67. (In Russ.) doi: 10.21508/1027-4065-2019-64-6-62-67

[8] Макаров Л.М., Комолятова В.Н., Киселева И.И., и др. Эпидемиология приступов потери сознания у детей и подростков в спорте высших достижений (исследование ЭПИЗОД-С) // Российский вестник перинатологии и педиатрии. 2019. Т. 64, № 6. С. 62–67. doi: 10.21508/1027-4065-2019-64-6-62-67

[9] Drezner JA, Fudge J, Harmon KG, et al. Warning symptoms and family history in children and young adults with sudden cardiac arrest. J Am Board Fam Med. 2012;25(4):408–415. doi: 10.3122/jabfm.2012.04.110225

[10] Drezner J.A., Fudge J., Harmon K.G., et al. Warning symptoms and family history in children and young adults with sudden cardiac arrest // J Am Board Fam Med. 2012. Vol. 25, N 4. P. 408–415. doi: 10.3122/jabfm.2012.04.110225

[11] Hastings JL, Levine BD. Syncope in the athletic patient. Prog Cardiovasc Dis. 2012;54(5):438–444. doi: 10.1016/j.pcad.2012.02.003

[12] Hastings J.L., Levine B.D. Syncope in the athletic patient // Prog Cardiovasc Dis. 2012. Vol. 54, N 5. P. 438–444. doi: 10.1016/j.pcad.2012.02.003

[13] Han J, Lalario A, Merro E, et al. Sudden cardiac death in athletes: facts and fallacies. J Cardiovasc Dev Dis. 2023;10(2):68. doi: 10.3390/jcdd10020068

[14] Han J., Lalario A., Merro E., et al. Sudden cardiac death in athletes: facts and fallacies // J Cardiovasc Dev Dis. 2023. Vol. 10, N 2. P. 68. doi: 10.3390/jcdd10020068

[15] Brignole M, Moya A, de Lange FJ, et al. Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):e43–e80. doi: 10.1093/eurheartj/ehy071

[16] Brignole M., Moya A., de Lange F.J., et al. Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope // Eur Heart J. 2018. Vol. 39, N 21. P. 43–80. doi: 10.1093/eurheartj/ehy071

[17] Shkolnikova MA, Polyakova EB, Ildarova RA, et al. Syncope in children and adolescents. Journal of Arrhythmology. 2017;(87):59–71. (In Russ).

[18] Школьникова М.А., Полякова Е.Б., Ильдарова Р.А., и др. Синкопальные состояния у детей и подростков // Вестник аритмологии. 2017. № 87. С. 59–71.

[19] Zavala R, Metais B, Tuckfield L, et al. Pediatric syncope: a systematic review. Pediatr Emerg Care. 2020;36(9):442–445. doi: 10.1097/PEC.0000000000002149

[20] Zavala R., Metais B., Tuckfield L., et al. Pediatric syncope: a systematic review // Pediatr Emerg Care. 2020. Vol. 36, N 9. P. 442–445. doi: 10.1097/PEC.0000000000002149

[21] Lisboa da Silva RMF, Oliveira PML, Tonelli HAF, et al. Neurally mediated syncope in children and adolescents: an updated narrative review. The Open Cardiovascular Medicine Journal. 2022;16. doi: 10.2174/18741924-v16-e2205110

[22] Lisboa da Silva R.M.F., Oliveira P.M.L., Tonelli H.A.F., et al. Neurally mediated syncope in children and adolescents: an updated narrative review // The Open Cardiovascular Medicine Journal. 2022. Vol. 16. doi: 10.2174/18741924-v16-e2205110

[23] Blevins B. Syncope for the general pediatrician. Curr Treat Options Peds. 2015;1:168–179. doi: 10.1007/s40746-015-0017-5

[24] Blevins B. Syncope for the general pediatrician // Curr Treat Options Peds. 2015. Vol. 1. P. 168–179. doi: 10.1007/s40746-015-0017-5

[25] Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2020;142(25):e558–e631. doi:10.1161/CIR.0000000000000937 Erratum in: Circulation. 2020;142(25):e633.

[26] Ommen S.R., Mital S., Burke M.A., et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines // Circulation. 2020. Vol. 142, N 25. P. 558–631. doi: 10.1161/CIR.0000000000000937 Erratum in: Circulation. 2020. Vol. 142, N 25. P. e633.

[27] Bozkurt B, Colvin M, Cook J, et al. Current diagnostic and treatment strategies for specific dilated cardiomyopathies: a scientific statement from the American Heart Association. Circulation. 2016;134(23): e579–e646. doi: 10.1161/CIR.0000000000000455 Erratum in: Circulation. 2016;134(23):e652.

[28] Bozkurt B., Colvin M., Cook J., et al. Current diagnostic and treatment strategies for specific dilated cardiomyopathies: a scientific statement from the American Heart Association // Circulation. 2016. Vol. 134, N 23. P. e579–e646. doi: 10.1161/CIR.0000000000000455 Erratum in: Circulation. 2016. Vol. 134, N 23. P. e652.

[29] Smith W; Members of CSANZ Cardiovascular Genetics Working Group. Guidelines for the diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ. 2011;20(12):757–760. doi: 10.1016/j.hlc.2011.07.019

[30] Smith W.; Members of CSANZ Cardiovascular Genetics Working Group. Guidelines for the diagnosis and management of arrhythmogenic right ventricular cardiomyopathy // Heart Lung Circ. 2011. Vol. 20, N 12. P. 757–760. doi: 10.1016/j.hlc.2011.07.019

[31] Makarov LM, Miroshnikova JuV, Poljaev BA, i dr. Metodicheskie rekomendaciĭ po kriterijam dopuska nesovershennoletnih sportsmenov k trenirovkam i sportivnym sorevnovanijam v sootvetstvii s vidom sporta, sportivnoĭ disciplinoĭ, polom i vozrastom pri zabolevanijah, patologicheskih sostojanijah i otklonenijah so storony serdechno-sosudistoĭ sistemy. Moscow: FMBA Rossii; 2019. (In Russ).

[32] Макаров Л.М., Мирошникова Ю.В., Поляев Б.А., и др. Методические рекомендаций по критериям допуска несовершеннолетних спортсменов к тренировкам и спортивным соревнованиям в соответствии с видом спорта, спортивной дисциплиной, полом и возрастом при заболеваниях, патологических состояниях и отклонениях со стороны сердечно-сосудистой системы. Москва : ФМБА России, 2019.

[33] Costa Oliveira C, Vieira C, Galvão Braga C, et al. Syncope in the athlete — minor changes, major diagnosis! Rev Port Cardiol. 2023;42(1):71.e1–71.e6. doi: 10.1016/j.repc.2019.08.012

[34] Costa Oliveira C., Vieira C., Galvão Braga C., et al. Syncope in the athlete — minor changes, major diagnosis! // Rev Port Cardiol. 2023. Vol. 42, N 1. P. 71.e1–71.e6. doi: 10.1016/j.repc.2019.08.012

[35] Sanatani S, Chau V, Fournier A, et al. Canadian cardiovascular society and Canadian pediatric cardiology association position statement on the approach to syncope in the pediatric patient. Can J Cardiol. 2017;33(2):189–198. doi: 10.1016/j.cjca.2016.09.006

[36] Sanatani S., Chau V., Fournier A., et al. Canadian cardiovascular society and canadian pediatric cardiology association position statement on the approach to syncope in the pediatric patient // Can J Cardiol. 2017. Vol. 33, N 2. P. 189–198. doi: 10.1016/j.cjca.2016.09.006

[37] Shkol’nikova MA, Kovalev IA, Leont’eva IV, editors. Sinkopal’nye sostojanija u detej. Moscow; 2016. (In Russ).

[38] Синкопальные состояния у детей / под ред. М.А. Школьниковой, И.А. Ковалева, И.В. Леонтьевой. Москва, 2016.

[39] Colivicchi F, Ammirati F, Santini M. Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J. 2004; 25(19):1749–1753. doi: 10.1016/j.ehj.2004.07.011

[40] Colivicchi F., Ammirati F., Santini M. Epidemiology and prognostic implications of syncope in young competing athletes // Eur Heart J. 2004. Vol. 25, N 19. P. 1749–1753. doi: 10.1016/j.ehj.2004.07.011

[41] Holtzhausen LM, Noakes TD, Kroning B, et al. Clinical and biochemical characteristics of collapsed ultra-marathon runners. Med Sci Sports Exerc. 1994;26(9):1095–1101.

[42] Holtzhausen L.M., Noakes T.D., Kroning B., et al. Clinical and biochemical characteristics of collapsed ultra-marathon runners // Med Sci Sports Exerc. 1994. Vol. 26, N 9. P. 1095–1101.

[43] Monda E, Rubino M, Lioncino M, et al. Hypertrophic cardiomyopathy in children: pathophysiology, diagnosis, and treatment of non-sarcomeric causes. Front Pediatr. 2021;9:632293. doi: 10.3389/fped.2021.632293

[44] Monda E., Rubino M., Lioncino M., et al. Hypertrophic cardiomyopathy in children: pathophysiology, diagnosis, and treatment of non-sarcomeric causes // Front Pediatr. 2021. Vol. 9. P. 632293. doi: 10.3389/fped.2021.632293

[45] Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet. 2017;389(10075):1253–1267. doi: 10.1016/S0140-6736(16)31321-6

[46] Veselka J., Anavekar N.S., Charron P. Hypertrophic obstructive cardiomyopathy // Lancet. 2017. Vol. 389, N 10075. P. 1253–1267. doi: 10.1016/S0140-6736(16)31321-6

[47] Arghami A, Dearani JA, Said SM, et al. Hypertrophic cardiomyopathy in children. Ann Cardiothorac Surg. 2017;6(4):376–385. doi: 10.21037/acs.2017.07.04

[48] Arghami A., Dearani J.A., Said S.M., et al. Hypertrophic cardiomyopathy in children // Ann Cardiothorac Surg. 2017. Vol. 6, N 4. P. 376–385. doi: 10.21037/acs.2017.07.04

[49] Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol. 2017;12(2):80–82. doi: 10.15420/ecr.2017:12:1

[50] Malhotra A., Sharma S. Hypertrophic cardiomyopathy in athletes // Eur Cardiol. 2017. Vol. 12, N 2. P. 80–82. doi: 10.15420/ecr.2017:12:1

[51] Rage M, Mohamed M, Nor MA, et al. Cardiomyopathy and sudden cardiac death among the athletes in developing countries: incidence and their prevention strategies. Cureus. 2023;15(2):e35612. doi: 10.7759/cureus.35612

[52] Rage M., Mohamed M., Nor M.A., et al. Cardiomyopathy and sudden cardiac death among the athletes in developing countries: incidence and their prevention strategies // Cureus. 2023. Vol. 15, N 2. doi: 10.7759/cureus.35612

[53] Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–1092. doi: 10.1161/CIRCULATIONAHA.108.804617

[54] Maron B.J., Doerer J.J., Haas T.S., et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006 // Circulation. 2009. Vol. 119, N 8. P. 1085–1092. doi: 10.1161/CIRCULATIONAHA.108.804617

[55] Eckart RE, Shry EA, Burke AP, et al. Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance. J Am Coll Cardiol. 2011;58(12):1254–1261. doi: 10.1016/j.jacc.2011.01.049

[56] Eckart R.E., Shry E.A., Burke A.P., et al. Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance // J Am Coll Cardiol. 2011. Vol. 58, N 12. P. 1254–1261. doi: 10.1016/j.jacc.2011.01.049

[57] Agbaedeng TA, Roberts KA, Colley L, et al. Incidence and predictors of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: a pooled analysis. Europace. 2022;24(10):1665–1674. doi: 10.1093/europace/euac014

[58] Agbaedeng T.A., Roberts K.A., Colley L., et al. Incidence and predictors of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: a pooled analysis // Europace. 2022. Vol. 24, N 10. P. 1665–1674. doi: 10.1093/europace/euac014

[59] Corrado D, Tintelen PJ, McKenna WJ, et al. Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis. Eur Heart J. 2020;41(14):1414–1429. doi: 10.1093/eurheartj/ehz669

[60] Corrado D., van Tintelen P.J., McKenna W.J., et al. Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis // Eur Heart J. 2020. Vol. 41, N 14. P. 1414–1429. doi: 10.1093/eurheartj/ehz669

[61] Cadrin-Tourigny J, Bosman LP, Wang W, et al. Sudden cardiac death prediction in arrhythmogenic right ventricular cardiomyopathy: a multinational collaboration. Circ Arrhythm Electrophysiol. 2021;14(1):e008509. doi: 10.1161/CIRCEP.120.008509

[62] Cadrin-Tourigny J., Bosman L.P., Wang W., et al. Sudden cardiac death prediction in arrhythmogenic right ventricular cardiomyopathy: a multinational collaboration // Circ Arrhythm Electrophysiol. 2021. Vol. 14, N 1. P. e008509. doi: 10.1161/CIRCEP.120.008509

[63] Rich L, Rarick J, Prahlow J. Arrhythmogenic right ventricular cardiomyopathy in a young athlete. Am J Forensic Med Pathol. 2021;42(1):64–66. doi: 10.1097/PAF.0000000000000616

[64] Rich L., Rarick J., Prahlow J. Arrhythmogenic right ventricular cardiomyopathy in a young athlete // Am J Forensic Med Pathol. 2021. Vol. 42, N 1. P. 64–66. doi: 10.1097/PAF.0000000000000616

[65] Wasfy MM, Hutter AM, Weiner RB. Sudden cardiac death in athletes. Methodist Debakey Cardiovasc J. 2016;12(2):76–80. doi: 10.14797/mdcj-12-2-76

[66] Wasfy M.M., Hutter A.M., Weiner R.B. Sudden cardiac death in athletes // Methodist Debakey Cardiovasc J. 2016. Vol. 12, N 2. P. 76–80. doi: 10.14797/mdcj-12-2-76

[67] Groeneweg JA, Bhonsale A, James CA, et al. Clinical presentation, long-term follow-up, and outcomes of 1001 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients and family members. Circ Cardiovasc Genet. 2015;8(3):437–446. doi: 10.1161/CIRCGENETICS.114.001003

[68] Groeneweg J.A., Bhonsale A., James C.A., et al. Clinical presentation, long-term follow-up, and outcomes of 1001 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients and family members // Circ Cardiovasc Genet. 2015. Vol. 8, N 3. P. 437–446. doi: 10.1161/CIRCGENETICS.114.001003

[69] Towbin JA, McKenna WJ, Abrams DJ, et al. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm. 2019;16(11): e301–e372. doi: 10.1016/j.hrthm.2019.05.007

[70] Towbin J.A., McKenna W.J., Abrams D.J., et al. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy // Heart Rhythm. 2019. Vol. 16, N 11. P. e301–e372. doi: 10.1016/j.hrthm.2019.05.007

[71] Gao Y, Zhang Q, Sun Y, Du J. Congenital anomalous origin of coronary artery disease in children with syncope: a case series. Front Pediatr. 2022;10:879753. doi: 10.3389/fped.2022.879753

[72] Gao Y., Zhang Q., Sun Y., Du J. Congenital anomalous origin of coronary artery disease in children with syncope: a case series // Front Pediatr. 2022. Vol. 10. P. 879753. doi: 10.3389/fped.2022.879753

[73] Cheitlin MD, MacGregor J. Congenital anomalies of coronary arteries: role in the pathogenesis of sudden cardiac death. Herz. 2009;34(4):268–279. doi: 10.1007/s00059-009-3239-0

[74] Cheitlin M.D., MacGregor J. Congenital anomalies of coronary arteries: role in the pathogenesis of sudden cardiac death // Herz. 2009. Vol. 34, N 4. P. 268–279. doi: 10.1007/s00059-009-3239-0

[75] Schnell F, Behar N, Carré F. Long-QT syndrome and competitive sports. Arrhythm Electrophysiol Rev. 2018;7(3):187–192. doi: 10.15420/aer.2018.39.3

[76] Schnell F., Behar N., Carré F. Long-QT syndrome and competitive sports // Arrhythm Electrophysiol Rev. 2018. Vol. 7, N 3. P. 187–192. doi: 10.15420/aer.2018.39.3

[77] Komoljatova VN, Makarov LM, Kolosov VO, I dr. Jelektrokardiograficheskie osobennosti u junyh jelitnyh sportsmenov. Pediatriya. Zhurnal im G.N. Speranskogo. 2013;92(3):136–140. (In Russ).

[78] Комолятова В.Н., Макаров Л.М., Колосов В.О., и др. Электрокардиографические особенности у юных элитных спортсменов // Педиатрия. Журнал имени Г.Н. Сперанского. 2013. Т. 92, № 3. С. 136–140.

[79] Makarov LM, Balykova LA, Gorbunova IA, Komolyatova VN. Changes in the QT interval during the test with dosed physical activity in healthy adolescents aged 11–15 years. Kardiologiia. 2012;52(9):15–21. (In Russ).

[80] Макаров Л.М., Балыкова Л.А., Горбунова И.А., Комолятова В.Н. Изменения интервала QT в процессе пробы с дозированной физической нагрузкой у здоровых подростков 11–15 лет // Кардиология. 2012. Т. 52, № 9. C. 15–21.

[81] Gomez AT, Prutkin JM, Rao AL. Evaluation and management of athletes with long QT syndrome. Sports Health. 2016;8(6):527–535. doi: 10.1177/1941738116660294

[82] Gomez A.T., Prutkin J.M., Rao A.L. Evaluation and management of athletes with long QT syndrome // Sports Health. 2016. Vol. 8, N 6. P. 527–535. doi: 10.1177/1941738116660294

[83] Sawyer TJ, Cianci M. Wolff–Parkinson–White in a college athlete: why didn’t we pursue an EP study? JACC Case Rep. 2022;9:101531. doi: 10.1016/j.jaccas.2022.05.036

[84] Sawyer T.J., Cianci M. Wolff–Parkinson–White in a college athlete: why didn’t we pursue an EP study? // JACC Case Rep. 2022. Vol. 9. P. 101531. doi: 10.1016/j.jaccas.2022.05.036

[85] Leung LWM, Gallagher MM. Review paper on WPW and athletes: let sleeping dogs lie? Clin Cardiol. 2020;43(8):897–905. doi: 10.1002/clc.23399

[86] Leung L.W.M., Gallagher M.M. Review paper on WPW and athletes: let sleeping dogs lie? // Clin Cardiol. 2020. Vol. 43, N 8. P. 897–905. doi: 10.1002/clc.23399

[87] Kabra N, Gupta R, Aronow WS, Frishman WH. Sudden cardiac death in Brugada syndrome. Cardiol Rev. 2020;28(4):203–207. doi: 10.1097/CRD.0000000000000259

[88] Kabra N., Gupta R., Aronow W.S., Frishman W.H. Sudden cardiac death in Brugada syndrome // Cardiol Rev. 2020. Vol. 28, N 4. P. 203–207. doi: 10.1097/CRD.0000000000000259

[89] Ayabe K, Komiyama T, Hasegawa M, et al. Clinical significance of the head-up tilt test in improving prognosis in patients with possible neurally mediated syncope. Biology. 2021;10(9):919. doi: 10.3390/biology10090919

[90] Ayabe K., Komiyama T., Hasegawa M., et al. Clinical significance of the head-up tilt test in improving prognosis in patients with possible neurally mediated syncope // Biology (Basel). 2021. Vol. 10, N 9. P. 919. doi: 10.3390/biology10090919

[91] Malloy-Walton L, Tisma-Dupanovic S. The approach to pediatric syncope with exercise. Heart Rhythm Case Rep. 2019;5(10):485–488. doi: 10.1016/j.hrcr.2019.04.012

[92] Malloy-Walton L., Tisma-Dupanovic S. The approach to pediatric syncope with exercise // Heart Rhythm Case Rep. 2019. Vol. 5, N 10. P. 485–488. doi: 10.1016/j.hrcr.2019.04.012

[93] Sharykin AS, Badtieva VA, Kljuchnikov SO, i dr. Kriterii dopuska sovershennoletnih lic k zanjatijam sportom (trenirovkam i sportivnym sorevnovanijam) v sootvetstvii s vidom sporta, sportivnoj disciplinoj, polom i vozrastom pri zabolevanijah, patologicheskih sostojanijah i otklonenijah so storony serdechno-sosudistoj sistemy. Metodicheskie rekomendacii. B.A. Poljaev, E.V. Shljahto, editors. Moscow: FMBA Rossii; 2020. 101 p. (In Russ).

[94] Шарыкин А.С., Бадтиева В.А., Ключников С.О., и др. Критерии допуска совершеннолетних лиц к занятиям спортом (тренировкам и спортивным соревнованиям) в соответствии с видом спорта, спортивной дисциплиной, полом и возрастом при заболеваниях, патологических состояниях и отклонениях со стороны сердечно-сосудистой системы. Методические рекомендации / под ред. Б.А. Поляева, Е.В. Шляхто. Москва : ФМБА России, 2020. 101 с.

RIGHTS & PERMISSIONS

Eco-Vector