Release of cardiac troponin using a high sensitivity assay after exercise: Type 2 acute myocardial infarction?
Tar Choon Aw1, Xander M R van Wijk2, Alan H B Wu3
1Changi General Hospital, Singapore.
Background:
Cardiac troponin is used as a marker for all types of myocardial infarction.
Methods:
Assays for high-sensitivity troponin T and I were performed before, immediately and 24h after a 40 km bicycle ride in two middle aged individuals.
Results:
There was a significant increase in cardiac troponin immediately after exercise in both individuals. This was accompanied by a return to baseline levels within 24h. A CT angiogram was normal in one while the other had a significant occlusion in the mid-right coronary artery. After a stent placement, in this latter individual, there was no major increase in troponin after a second bicycle ride.
Conclusions:
Using high sensitivity assays, at least one of these two subjects may have suffered a type 2 myocardial infarction had the increases in hs-cTnI were accompanied by other acceptable evidence of myocardial ischemia (symptoms, ECG, etc.).
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