Based upon numerous reported cases and despite widespread beliefs to the contrary, sickle cell trait (SCT) may be deemed a quantifiable risk factor in certain subsets of patients. As a result of common misconceptions regarding SCT, most individuals with the condition are generally not informed regarding the possible consequences of certain activities such as venturing to high altitudes or participating in overly exertional physical activities. Acute exertional rhabdomyolysis is a potentially serious clinical illness and is caused by skeletal muscle injury resulting in the release of myoglobin and other cellular contents, including creatine kinase, into the circulatory system. Mild to moderate cases of acute exertional rhabdomyolysis can cause metabolic disorders including hypernatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, lactic acidosis and hyperuricemia. Severe cases may result in renal failure and even death. Several case reports have been published since the early 1970s describing significant morbidity and mortality of acute exertional rhabdomyolysis in patients with SCT. We present the case of a 27-year-old male with a past medical history significant only for SCT who presented after a 1.5 mile run with severe exertional rhabdomyolysis and subsequent acute renal failure requiring hemodialysis (HD). In presenting this case, we hope to raise awareness of a possible underlying cause to many cases of exertional rhabdomyolysis and encourage physicians to counsel their patients with SCT in order to avoid the significant morbidity and mortality that may be associated with the condition.

The agents used for nuclear stress testing (NST) including adenosine, dobutamine, and dipyridamole, are generally well tolerated and the incidence of serious complications associated with their use in NST is relatively low. Adenosine possesses a potent inhibitory effect on the atrioventricular (AV) node and may induce a transient conduction defect which could result in first-, second-, or third-degree heart block in some patients. The use of the potent AV nodal blocker adenosine for nuclear stress testing in patients with evidence of underlying conduction system disease may result in serious complications. We present the case of a 79-year-old man who had sustained second-degree AV block requiring permanent pacemaker implantation following adenosine infusion for nuclear stress testing. We also review the literature regarding the association between adenosine NST and AV block.

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