Clinical Review

Grand Rounds--Hammersmith Hospital: Hazards of running a marathon

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7086.1023 (Published 05 April 1997) Cite this as: BMJ 1997;314:1023

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Creatine Kinase MB can be raised without myocardial infarction

  1. G R ThompsonCase presented by, professor of clinical lipidology,
  2. J Scott, Chairman, professor of medicine,
  3. M J WalportDiscussion group, professor of rheumatology,
  4. C M Oakley, professor of clinical cardiology,
  5. J M B Hughes, professor of thoracic medicine,
  6. C J Bulpitt, professor of geriatric medicine,
  7. S D Taylor RobinsonDr, Series edited by
  1. Clinical Sciences Centre, Royal Postgraduate Medical School, Hammersmith Hospital, London W12 0NN

    Introduction

    The notion that participating in strenuous physical exertion could be hazardous to health dates from 490 bc, when Pheidippides allegedly dropped dead after running 39 km to Athens and delivering news of victory over the Persians on the battlefield at Marathon.1

    Case history

    A 61 year old physician volunteered to run in the 1993 London marathon to raise money for a medical charity. He trained for the previous four months, running an average of 35 km a week, and in the marathon he completed the 42.2 km in about 4.5 hours. His race was uneventful apart from a brief spell of dizziness towards the end, which was relieved by carbohydrate and which he attributed to hypoglycaemia. Earlier in the race he had passed a middle aged runner who was being resuscitated unsuccessfully after sustaining a cardiac arrest.

    Apart from myalgia in his legs he felt well after the race (fig 1) and dined out with friends and relatives that evening. He went to work as usual the next day, but in view of the persistence and severity of his myalgia he had blood taken for measurement of serum creatine kinase activity. The results showed a total creatine kinase activity of 1800 IU/l (normal <200 IU/l) and a creatine kinase MB of 38 ng/ml (normal <6 ng/ml). The chemical pathology registrar on duty regarded these values as pathognomonic of myocardial infarction. However, in view of his general wellbeing and lack of cardiorespiratory symptoms the physician discounted this diagnosis. His myalgia gradually subsided, and he was jogging again within a week.

    Fig 1

    61 Year old physician after runnning the London marathon–apart from myalgia in his legs he felt well

    Because of his secretary's success in raising sponsorship money the physician won a free trip to participate in the New York marathon later that year. …

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