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Treat the patient not the blood test: The implications of an elevation in cardiac troponin following prolonged endurance exercise.
  1. Gregory P Whyte (gregwhyte27{at}yahoo.co.uk)
  1. Liverpool John Moores University, United Kingdom
    1. Nigel Stephens (nigel_stephens{at}btinternet.com)
    1. Northwick Park Hospital, United Kingdom
      1. Roxy Senior (r.senior{at}nph.nhs.uk)
      1. Northwick Park Hospital, United Kingdom
        1. Keith P George (k.george{at}livjm.ac.uk)
        1. Liverpool John Moores University, United Kingdom
          1. Robert Shave (rob.shave{at}brunel.ac.uk)
          1. Brunel University, United Kingdom
            1. Mathew Wilson (mat.wilson{at}boa.org.uk)
            1. CRY Centre for Sports Cardiology, United Kingdom
              1. Sanjay Sharma (ssharma21{at}hotmail.com)
              1. Kings College Hospital, United Kingdom

                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.

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