Release of cardiac troponin using a high sensitivity assay after exercise: Type 2 acute myocardial infarction?

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 24. h 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 24. h. 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.). demand imbalance.