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Evidence of Myocardial Injury During Prolonged Strenuous Exercise*

      Competitive athletes such as long-distance runners typically manifest markedly elevated total creatine kinase (CK) enzyme serum levels, representing skeletal muscle trauma, when measured shortly after exercise. Because skeletal muscle contains a small proportion of the “cardiac” MB fraction of CK, this isoenzyme is sometimes elevated as well.[
      • Schneider CM
      • Dennehy CA
      • Rodearmel SJ
      • Hayward JR
      Effects of physical activity on creatine phosphokinase and the isoenzyme creatine kinase-MB.
      ]Thus, assurance that no cardiac injury has occurred is problematic in this setting. Recently, the detection of an elevated cardiac troponin T serum level has been found to be very specific in detecting myocardial injury[
      • Gerhardt W
      • Ljungdahl L
      • Herbert A-K
      Troponin-T and CK MB (mass) in early diagnosis of ischemic myocardial injury.
      ,
      • Ravkilde J
      • Hørder M
      • Gerhardt W
      • Ljungdahl L
      • Pettersson T
      • Tryding N
      • Møller BH
      • Hamfelt Å
      • Graven T
      • Asberg A
      • Helin M
      • Penttilä I
      • Thygesen K
      Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction.
      ]and has become clinically available. Isolated brief reports have been in conflict regarding the suggestion of myocardial injury in high-intensity exertion as determined by elevated serum troponin T levels.[
      • Artner-Dworzak E
      • Mair J
      • Seibt I
      • Koller A
      • Haid C
      • Puschendorf B
      Cardiac troponin T identifies unspecific increases of CKMB after physical exercise [.
      ,
      • Koller A
      • Mair J
      • Mayr M
      • Calzolari C
      • Larue C
      • Puschendorf B
      Diagnosis of myocardial injury in marathon runners.
      ]
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      References

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        Effects of physical activity on creatine phosphokinase and the isoenzyme creatine kinase-MB.
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        Troponin-T and CK MB (mass) in early diagnosis of ischemic myocardial injury.
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        Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction.
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