We report the occurrence of rhabdomyolysis and heart failure in a previously healthy person after exercise and sauna.

A 33-year-old man referred himself to our center because of dark urine. One day earlier, after strenuous exercise (primarily weight lifting), he sat in a sauna for approximately 15 minutes. Although he had done similar exercise irregularly before, he had never used the sauna immediately afterward. The next day, he had muscular soreness and noted dark urine. He denied previous illnesses and the intake of medications, drugs, or alcohol. Physical examination showed no distress, fever, or abnormal findings other than muscle tenderness. The urinalysis result was positive for blood by dipstick, but microscopy showed no erythrocytes. His serum creatine kinase was 39 720 IU/L; his serum electrolyte, urea, and creatinine levels were normal. An electrocardiogram was within normal limits.

To prevent renal failure from rhabdomyolysis [1], the patient received vigorous intravenous hydration at a rate of approximately 0.5 L/h. Over the ensuing 2 days, his renal function remained normal; physical examination showed edema, jugular venous distention, and weight gain. A chest radiograph revealed cardiomegaly and pulmonary edema. Echocardiography and radionuclide ventriculography showed moderate left ventricular function, with an ejection fraction of 46%; the right ventricle was enlarged, with an ejection fraction of 39%. Inferoapical hypokinesis was also evident. After discontinuation of fluids and administration of furosemide, all signs of heart failure resolved. Graded exercise testing yielded no evidence of metabolic myopathy [2], and isometric hand-grip exercise elicited a normal rise and decline in peripheral venous lactate [3]. The patient has since returned to his normal activities and has remained well for the subsequent 6 months.

This case shows the development of rhabdomyolysis and cardiac failure in a healthy man after strenuous exercise followed by a sauna bath. Although sauna can cause heat exhaustion and rhabdomyolysis may follow exertional heat stroke, a MEDLINE search identified no similar reports. Because transient myocardial depression may follow heat stroke, caution should be used in the aggressive administration of fluids [4]. Patients should be aware of the potentially harmful consequences of sauna use after vigorous exercise.