Treat the patient not the blood test: The implications of an elevation in cardiac troponin following prolonged endurance exercise

Gregory P Whyte ^1*, Nigel Stephens ², Roxy Senior ², Keith P George ¹, Robert Shave ³, Mathew Wilson ⁴ and Sanjay Sharma ⁵

¹ Liverpool John Moores University, United Kingdom
² Northwick Park Hospital, United Kingdom
³ Brunel University, United Kingdom
⁴ CRY Centre for Sports Cardiology, United Kingdom
⁵ Kings College Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: gregwhyte27{at}yahoo.co.uk.

Accepted 6 January 2007

Abstract

A 43-year-old triathlete collapsed following successful completion of an Ironman triathlon and was referred to the cardiology department of the local hospital. The athlete was hospitalized for 4 days in a high dependency unit where he underwent extensive non-invasive and invasive testing. Associated with a mildly elevated cardiac troponin-I and minor ST segment elevation on ECG and despite normal echocardiography the athlete was diagnosed with mild myopericarditis and instructed to abstain from exercise for 6 weeks. On follow-up examination, 2 weeks post hospitalization; there was no evidence of myopericarditis. Elevated cardiac troponins are common following ultra-endurance exercise as are ECG anomalies in highly trained athletes. This case highlights the potential for mis-diagnosis of myocardial injury following prolonged exercise.

Key Words: ironman triathlon, myocardial damage, troponin

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