Swimming-Induced Pulmonary Edema With Concomitant Myocardial Injury: Case Report and Review of the Literature

Swimming-induced pulmonary edema (SIPE) is an underrecognized cause of acute dyspnea in healthy athletes. Risk factors include older age, female sex, asthma, and underlying cardiopulmonary disease.

A 49-year-old man developed acute dyspnea during the swimming portion of a triathlon. On presentation, he exhibited hypoxemia, crackles, and radiographic pulmonary edema. Troponin elevation prompted further cardiac imaging, revealing preserved left ventricular function and focal acute myocardial edema. He was diagnosed with SIPE with concomitant myocardial injury; his condition improved with supportive care.

SIPE is a hydrostatic imbalance triggered by cold-water immersion, exertion, and external thoracic compression. Symptoms resolve rapidly with supportive care, and outcomes are generally positive, but recurrence can occur in up to 28% of patients. The presence of myocardial injury is an uncommon finding in SIPE, and it is unclear if this finding preceded or was secondary to it.

SIPE may present with atypical findings including myocardial injury, and cardiologists must be vigilant to prevent misdiagnosis.