CASE REPORTS
Commentary on "Treat the patient not the blood test: the implications of an increase in cardiac troponin after prolonged endurance exercise"
University of Cape Town, South Africa; timothy.noakes@uct.ac.za
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Most cases of collapse after exercise are due to the persistence into recovery of a state of low peripheral resistance, to which "dehydration" probably plays no meaningful part. Thus the optimum treatment of collapse after exercise is to nurse the patient in the head-down position. This is usually remarkably effective, returning the systolic blood pressure to above 100 mm Hg and instantly reversing any symptoms of postural hypotension.
Had the physicians who first encountered this patient been aware that some athletes have a great capacity for peripheral vasodilatation and the development of postural hypotension under specific conditions, the patient would have been spared unnecessary interventions and the costs the authors describe. There is an old saying that athletes should only ever accept the opinion of a doctor who is also an athlete, or at least has some passing understanding of sports medicine.
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