A 32-Year-Old Female Who Had Syncope After Running a Marathon Presents to the ED

A 32-year-old female who had syncope after running a marathon presents to the ED. She reported that while running the last 3 to 4 miles she began feeling dizzy but did not stop for water because she wanted to complete the marathon in a personal best of <4½ hours. Crossing the finish line she had a syncopal episode that lasted approximately 1-2 minutes. There was no associated bowel or bladder incontinence. On awakening she had no significant memory loss and did not injure herself. She denied any chest pain, pressure, or shortness of breath other than associated with running. She was taken immediately to a medical tent and she received 1 liter of normal saline prior to ED arrival. On arrival at the emergency department she was relatively asymptomatic. She denied any symptoms other than feeling a little dizzy on sitting up. 

PmHX: negative
Social: no tobacco use, intermittent alcohol use
FmHX: no premature CAD
Medications: ibuprofen prn

Physical Exam:
BP 100/60 mmHg, P 100 bpm that changed on sitting upright to SBP 85 mmHg with a HR of 125 bpm. The rest of her physical exam was normal.

BUN 20 mg/dl
Cr mg/dl
Hgb NL
TnT 0.10 ng/mL
CKMB 12.6 ng/ml
CK 400 U/L
Lipid panel: total cholesterol 260 mg/dl, LDL 135 mg/dl, HDL 75 mg/dl, TG 50 mg/dl.


Because of the elevated TnT she was admitted for observation.
Repeat TnT were 0.09 and 0.03 ng/ml

If you had a choice of only one diagnostic test, which test would you perform?

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