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.
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