As I mentioned briefly in my race report for the 2009 Las Vegas Marathon I ended up spending a night in the hospital following the race. I feel obligated to post a few things about that event. I don’t want anyone that comes across this blog to be discouraged by what happened. After you read this post I hope you’ll agree that it was just a big misunderstanding and that I didn’t really need to be hospitalized (but I blame no one for what happened).
After the race I promptly sat down and was offered help by many volunteers. At first I refused. I just wanted to catch my breath and rest a bit. But then the center of my chest started to hurt. It hurt at the top of my inhale and the bottom of my exhale. All I had to do was look at a volunteer and they were at my side helping me to the medical tent. The volunteers did a great job.
Chest pains are taken very seriously especially at endurance events. Somewhere between 1 in 50,000 and 1 in 75,000 participants will die due to heart related problems. In almost every case it is due to a pre-existing and undiagnosed heart condition.
The EMTs talked asked me a bunch of questions and did an ekg. They didn’t really like what they saw and recommended that I go to the hospital for further evaluation. I wasn’t about to argue with them even though I never felt that I was in any danger.
At the ER they took blood, did a chest x-ray, and monitored me. The blood work was, among other things, to look at some blood markers that appear during heart attacks. One of those markers is troponin. I’ve was told that this chemical is released into the blood when heart cells die, and only when heart cells die. I’ve since learned that troponin can be present in the blood from other sources (other muscles). Still, it’s an excellent tool that doctor’s can use to determine if a heart attack has occurred. If the levels rise over a perioid of time then the liklihood of a true heart attack increases. My troponin levels rose beyond the pre-defined thresholds and so they recommended that I stay over night for fruther testing and to have a stress test the following morning.
So, instead of going out on the Vegas strip to celebrate my friends and family stopped by to see me in the hospital. Ugh. As unhappy as I was sitting there it was the right thing to do. Over night they took more blood samples and my troponin continued to rise. The following morning I had the stress test done.
The stress test was not the typical treadmill based test. This test included nuclear imaging. Instead of increasing my heart rate via exercise they injected a chemical agent that made my heart race. They took nuclear images for my unstressed heart and when it was stressed. About one hour after this test I was released because the stress test showed no damage. I was instructed to follow up at home with my primary care physician.
I followed up at home with a cardiologist. The outcome of talking with him (and taking an exercise induced stress test) is that I’m completely fine. None of the tests indicate a heart problem.
So what happened then? Why did my troponin rise? What was the source of the pain? I believe the pain was respiratory in nature and at least one person at the cardiology center agreed that I was likely correct. The elevated troponin is expected in marathon runners! The limited data available shows that almost every participant will have elevated troponin. The source of that might be from the heart or from other muscles in the body. I ended up being hospitalized because doctors don’t have data about marathoners. They have to base their decisions on the data that they do have. When the troponin levels rise in a sedentary person it is cause for concern.
The cardiologist printed journal articles for me related to the topic and said “bottom line: there’s nothing to worry about.” The data indicates that elevated troponin is normal in endurance events.
My theory is that some heart cells die as part of the normal adaptation process. When you develop muscles you damage them and they grow back stronger. Why should the heart be that much different? It is known that the hearts of endurance athletes grows larger and adapts to the stresses we place on them. I suspect it is not dangerous and is in fact beneficial.
That single incident cost almost $30,000. My primary care physician said “that’s criminal.” I hope my insurance company investigates the charges. If they are legit that’s fine but 30k seems like an awful lot of money for something like this.
My next marathon is in 1 week. In one way I’m glad I went through this ordeal. I’m now more confident than ever that I do not have a heart condition to worry about. I can train and run races and enjoy life.
Get out there and run!