Trying to understand my most recent ED visit/event
I am a 32-year-old male, 6 feet 4 inches tall, at 246 pounds. I am very active in martial arts, running, walking, and weightlifting, albeit still obviously overweight. My resting heart rate is generally around 55–65 bpm. My blood pressure could be improved; it’s often at 136/77-ish, give or take a few points in each direction for both. I don’t eat fast food; I eat fairly clean and get okay sleep. No health conditions except exercise-induced asthma that has been extremely mild.
Saturday I decided to do some intense cardiovascular fitness training as I am training for a fitness test for a new career. I was doing the 1.5-mile test. I ran at a great pace, and a few times I hit my max heart rate (with the 220-age method). I had sustained at least 13:55 minutes of intense exercise. After the run I felt fantastic! I pushed myself; I got a good baseline and felt good.
20 minutes later, I’m coughing a lot, phlegm in my throat, my throat and chest get tight. I can’t breathe; my pulse, which had dropped to 100, was bouncing between 160 and 135 at rest. I begin true hyperventilation and a panic attack ensues. Tingly lips, tight jaw, felt like I couldn’t breathe and was going to faint. I called 911 and they came and took me to the hospital. My vitals are good; my pulse hung out around 110 for about an hour. Oxygen throughout the whole time was 99–100%. EKG was clean except a possible right bundle branch block incidental finding. Lung X-ray is clean.
Doctor does comprehensive blood work; I was slightly dehydrated; otherwise things look good. Gives me a breathing treatment with albuterol nebulizer. In 5 minutes my throat and chest relax, no longer feeling like I can’t breathe. Heart rate comes down to 70 in about 3 hours. Then hangs around 65–70 rest of night.
Troponin levels: 10 ng/L, then 2 hours later 27 ng/L, then 6 hours after incident 36 ng/L. Threshold for concern according to doctor is 45 ng/L. Doctor sends me home. He did note there was slight wheezing at the end of my breath before I left, even after nebulizer treatment.
I did continue to have panic attacks off and on the next few days, lessening as time went on. Today (4 days later) I finally feel normal, likely due to the adrenaline and just sheer terror of the event wearing off. I do have a history of panic following my second COVID vaccination (not anti-vaccine), but it’s just observed with my doctors. I never had a panic attack in my life beforehand, still mostly glad I got vaccinated. The response was within a day from my second shot several years ago.
Hopefully that’s enough background for my question.
Why do you think my ER doc said it was fine to go home even though my troponin levels were increasing? I know the delta between the first and second test was 17, and the delta between the second and third was only 9, which would indicate a decrease in change. But how do we know in 24 hours it’s not really high or a concerning level? He said that he believed it was an exercise-induced asthma attack mixed with a panic attack. I agree. I’m not a doctor, just a medical physicist haha, so I don’t know much outside of radiation testing. I have been seen by my PCP yesterday who said my heart sounded perfect, no irregularity or murmurs or anything. My lungs sound good except a slight wheeze at the end of a big exhale; otherwise clean bill of health. He also said it sounds like exercise-induced asthma or maybe I am developing mild asthma later in life. He cleared me for exercise but advised me to keep inhaler on hand for the time being. How do you interpret this event? I tend to agree with them, just logically, but I’m trying to figure out the troponin logic. I will admit I am a little nervouse to exercise! Would love some insight! Thank you!