Elevated troponin levels in an athlete: Myocardial infarction or a physiological reaction?

Introduction/Objective Measuring blood troponin levels is a fundamental laboratory analysis for every patient with chest pain and other non-specific complaints associated with the onset of an acute myocardial infarction (AMI). Although increased blood troponin levels are a precise indicator of AMI, their values can also be elevated in other acute heart diseases. It has been recorded for years that intense physical activity is also linked to the release of troponin, even though the pathophysiological mechanism had not yet been described. This paper aims to present the case of a patient who had collapsed in a public setting during physical activity and was taken to the hospital with the suspicion of having an AMI. However, even though lab analyses detected high blood troponin levels, AMI was ruled out by heart ECHO and coronary angiography. Patient report A 45-year-old patient was a professional athlete who had collapsed after an 8 km run and briefly lost consciousness. He denied experiencing chest pain, difficulty breathing, palpitations, headaches, or dizziness in the moments preceding the event. His ECG showed sinus rhythm, his heart rate was 61/min, and the cardiac axis had not shifted, but he did have an inverted T wave in V1 and a hyperacute T wave in V3. He was taken to the hospital by ambulance, where the laboratory results showed increased levels of troponin I. During hospitalisation, acute coronary syndrome (ACS) was excluded, as well as structural heart disease with heart ECHO, and no arrhythmias were recorded. The conclusion was drawn that the elevated troponin levels were most likely the result of intense physical activity. Conclusion Medical work in the field raises its own diagnostic doubts. Any type of chest pain or other symptoms that may point to a possible acute coronary syndrome require special attention from the emergency physician. Emergency physicians must also be acquainted with the vast pathology of potential consequences of strenuous physical activity, both in professional and non-professional athletes.