Syncope in an Athlete With Apical Hypertrophic Cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Apical Hypertrophic Cardiomyopathy (n=1). Intervention: Continued sports participation with hydration counseling and monitoring. Primary outcome: Recurrent syncopal events.

Q: What does this research mean for the field?

Syncope evaluation in athletes with hypertrophic cardiomyopathy necessitates individualized risk stratification and shared decision-making to distinguish benign from life-threatening etiologies. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Suhas Tatapudi; John-Henry L. Dean; Krishna Pabba; Matthew W. Martinez

doi:10.1016/j.jaccas.2026.107150

March 1, 2026JACC Case ReportsOpen Access

Syncope in an Athlete With Apical Hypertrophic Cardiomyopathy

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Key result

Assessing syncope in athletes with HCM requires individualized risk stratification and shared decision-making.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Syncope in athletes with HCM requires careful evaluation because etiologies range from benign to life-threatening.

Key Points

To determine the underlying mechanism of syncope in a competitive athlete diagnosed with apical hypertrophic cardiomyopathy and establish safe return-to-play criteria.
Evaluated a 20-year-old male basketball player presenting with positional syncope using electrocardiography, cardiac imaging, and maximal-effort exercise stress testing.
Implemented a conservative management strategy consisting of hydration counseling, annual surveillance imaging, rhythm monitoring, and genetic evaluation.
Diagnostic imaging confirmed apical hypertrophic cardiomyopathy without resting or provokable left ventricular outflow tract obstruction.
Maximal-effort stress testing demonstrated no exertional arrhythmias, establishing a primary diagnosis of orthostatic syncope in a preload-dependent ventricle.
The athlete successfully resumed competitive sports participation without recurrent syncopal episodes under longitudinal monitoring.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 20-year-old male basketball player with apical hypertrophic cardiomyopathy who experienced orthostatic syncope and was evaluated for return-to-play.

E

Exposure

Continued sports participation with hydration counseling, annual imaging, rhythm monitoring, and genetic evaluation.

O

Outcome

Recurrent syncopal events

Individualized risk stratification and shared decision-making can allow athletes with apical HCM and orthostatic syncope to safely continue sports participation.

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Implication

Mandates caution distinguishing benign versus malignant syncope in HCM athletes; extends risk models and leaves open definitive management pathways.

Abstract

BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGE: Syncope in athletes with HCM warrants comprehensive evaluation and tailored return-to-play decisions.

Discussion

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Cite This Study

Tatapudi et al. (2026) conducted a case report in Apical Hypertrophic Cardiomyopathy (n=1). Continued sports participation with hydration counseling and monitoring was evaluated on Recurrent syncopal events. Continued sports participation with hydration counseling and monitoring in a 20-year-old athlete with apical hypertrophic cardiomyopathy and orthostatic syncope resulted in 0 recurrent events.

synapsesocial.com/papers/69c770c08bbfbc51511e0af4 https://doi.org/10.1016/j.jaccas.2026.107150

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Syncope in an Athlete With Apical Hypertrophic Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Syncope in an Athlete With Apical Hypertrophic Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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