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Myocardial infarction during a football game: Empiric estimation of the contribution of skeletal muscle damage to the serum creatine kinase activity

A 40‐year‐old untrained participant of a competitive football game experienced chest pain after 20 minutes of playing time. An acute anterior myocardial infarction was diagnosed by electrocardiographic criteria and the creatine kinase rose to its maximum of 3900 U/l (normal range < 125 U/I) by 24 h with a CK‐MB fraction of 6.1% In order to estimate the contribution of skeletal muscular work to CK activity, the course of CK activity was prospectively measured in 11 untrained participants of a competitive football game, who had normal electrocardiographic findings on exercise testing. Individual peak values of CK correlated positively (p < 0.01) with the time spent in play. Based on this observation we could estimate that, at most, 14% of the total CK was contributed by skeletal muscle damage in our patient. When total CK was elevated above 125 U/I, the percentage of CK‐MB activity did not exceed 6% of total CK in any case. 3‐methylhistidine, an indicator of contractile protein turnover and creatinine were prospectively determined in spot urine samples before the game and for up to 48 h after the game. 3‐methylhistidine/creatinine ratios did not change from baseline after the game and no correlation with CK was found. Urine 3‐methylhistidine/creatinine, measured within 48 h after a football game, does not contribute to the quantification of skeletal muscle damage.