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Heart issues at CDA 70.3 run
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Looking for help / suggestions.
I raced CDA 70.3 a couple of weeks back and had a bit of a heart rate episode. Here is the nutshell version. For a full report feel free to read at enduranceloop.ca/blog
During swim warm up I felt a short episode of a skipped beat and subsequent flat and fast beats – as if the heart is trying to make up for that skipped beat. Only lasted about 30 seconds. I have had a few of those in 2012 and got a good checkup (including stress ECG (well, as much stress as those are), and ultrasound, but nothing was found besides a slight right side branch block. I have accepted I have those short episodes every once in a while, so I didn’t think much of it and raced anyways.
Swim and bike went okay, stayed within my HR target for the bike (142) and felt good. Coming out of transition HR was a tad high so I went slow to meet my target (152) and boom - hr went up to 184- 189. That is definitely not a HR I can not sustain - I max out at around 180. I manually felt my pulse and it was indeed fast and very flat. Weirdly I felt fine though and jogged on.
After about 10 minutes of this the HR dropped just as fast as it had increased (see attached image). But HR stayed at around 162 – 167, again, based on training definitely not something I can maintain for a half marathon. I went through the race carefully, insecure but feeling okay. Post race my HR took forever to go down, stayed at 120 for a good half hour or so.
For a couple of weeks post race my HR still sky rocketed when I went running (seemed okay on the bike), and I had a lot more of these skipped beat type episodes – like 6 – 10 a day? Family doctor says these are just Premature Ventricular Contractions (PVCs) and nothing to worry about. ECG is normal it seems. I felt sluggish, headachey and overall not happy though.
Since the beginning of this week (July 17) I have drastically improved, almost no more PVCs and only slightly elevated HR on runs any more. Given our amazing health care system my appointment with a cardiologist (made the day after the race (June 26)) will be on August 29....by then I will be completely back to normal I am afraid (well I am glad, but I will have nothing to show any more...)
Any suggestions, similar experiences etc. here?
The irony is that I am racing to raise money for stroke research (hence that enduranceloop webpage) because my dad – an avid Ironman competitor and a picture of health - died of a stroke at the age of 59. I am only 42 and I really do not want to follow in his footsteps on that front.
Any help would be appreciated!
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Re: Heart issues at CDA 70.3 run [Holger] [ In reply to ]
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It sounds exactly like a-fib.
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Re: Heart issues at CDA 70.3 run [craigj532] [ In reply to ]
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You could always get one of these and wear during your events. Not cheap, but at least you'd know for sure.

https://www.getqardio.com/...zEAAYASAAEgLoR_D_BwE
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Re: Heart issues at CDA 70.3 run [craigj532] [ In reply to ]
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craigj532 wrote:
It sounds exactly like a-fib.

Sounds almost exactly like what I experienced prior to my a-fib diagnosis. The first time I had an episode (2 years ago), the first time was the most severe, and then subsequent episodes were milder and came on less often, until by the time my cardiologist was able to see me and give me a stress ECG the problem seemed to have completely corrected itself. At the time it was just chalked up to lingering effects from a severe leg infection I had 2 weeks before the first episode, which occurred on my first ride after the infection.

But back in March it came back with a vengeance (one episode lasted almost 4 weeks), and this time it was diagnosed right away due to an already scheduled ECG...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Heart issues at CDA 70.3 run [Warbird] [ In reply to ]
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I would not jump to negative conclusions (i.e. a-fib).

It could be a lot of things. Comments/questions/possibilities
1) How do you know that you can't keep your heart rate above (160 or whatever)?
Your heart rate doesn't seem that high to me. The 70.3 run is a good place for a high heart rate.
2) Could your heart rate data be incorrect?
3) The period in your graph where the heart rate is especially high is probably a technical glitch. It looks like a glitch to me- comes on suddenly and disappears suddenly.
Why isn't it just a glitch?
4) Did you run fast?
5) Dehydration + a tendency for PVCs-could explain your symptoms.
6) Heat exhaustion + a tendency for PVCs- could also explain your symptoms.
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Re: Heart issues at CDA 70.3 run [Holger] [ In reply to ]
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PVCs don't cause HR to go to 180. It could be a.fib or paraoxysmal (sic) atrial fibrillation (PAT). Which is a regular rapid rate starting in the upper part of your heart. Either can be frustrating to prove until you catch it on a heart tracing. Ask you gp if they can do a 14 day holter which is a device you wear for 14 days and if you feel HR going rapid it can record what is occurring. If you have that before you see cardiologist and it catches it you likely have diagnosis.

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

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Re: Heart issues at CDA 70.3 run [Velocibuddha] [ In reply to ]
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Velocibuddha wrote:
3) The period in your graph where the heart rate is especially high is probably a technical glitch. It looks like a glitch to me- comes on suddenly and disappears suddenly.
Why isn't it just a glitch?

That area on the OP's graph looks like most of my shorter attacks: HR suddenly jumps 30, 40, even as much as 165bpm, stays there for a few seconds to a few minutes, and then suddenly drops back down to the previous level.

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Heart issues at CDA 70.3 run [craigj532] [ In reply to ]
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craigj532 wrote:
It sounds exactly like a-fib.

that's exactly what I was going to say. As someone who has dealt with it in the past. Mine was a 'man I'm short of breath sitting here at my desk' + check pulse = 'fast, pounding heart rate followed by 2-3 seconds of no beats'. Which made sense once I got to the ER and could watch my pulse go from 190 to 30 to 160 to 45, all in the span of a minute.

I don't think a regular EKG/ECG would necessarily show you as being susceptable unless you are in afib at the time. As your cardio guy to give you a holter monitor - you have to wear it 24/7 for a week or so - it'll catch any episodes, even the ones you don't feel.

Hopefully it's not this for you. Mine was corrected via ablation in 2015, and I haven't felt any episodes since. If it is this, MDs will prescribe a beta blocker and probably a blood thinner too. The former sucks, the latter not so much.
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Re: Heart issues at CDA 70.3 run [Warbird] [ In reply to ]
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Warbird wrote:
Velocibuddha wrote:
3) The period in your graph where the heart rate is especially high is probably a technical glitch. It looks like a glitch to me- comes on suddenly and disappears suddenly.
Why isn't it just a glitch?

That area on the OP's graph looks like most of my shorter attacks: HR suddenly jumps 30, 40, even as much as 165bpm, stays there for a few seconds to a few minutes, and then suddenly drops back down to the previous level.

Ok ......but that is also one of the way it looks when my heart rate monitor gives off a false reading.

The thing that I find suspicious about that segment is that we do not see other signs of stress. I would expect a dramatic loss of performance and a greater sensation of distress.
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Re: Heart issues at CDA 70.3 run [len] [ In reply to ]
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len wrote:
PVCs don't cause HR to go to 180. It could be a.fib or paraoxysmal (sic) atrial fibrillation (PAT). Which is a regular rapid rate starting in the upper part of your heart. Either can be frustrating to prove until you catch it on a heart tracing. Ask you gp if they can do a 14 day holter which is a device you wear for 14 days and if you feel HR going rapid it can record what is occurring. If you have that before you see cardiologist and it catches it you likely have diagnosis.

PVCs sure can cause an HR to go to 180. Sinus Rhythm at 90bpm followed by a PVC after each beat is a 180 bpm. The reality is there are a bunch of different rhythms that could exist. WPW could be the cause. Regardless they can find something on a holter if you are lucky, but then it might be a completely different rhythm than what happened on race day. The heart can be very tricky


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Re: Heart issues at CDA 70.3 run [Thomas Gerlach] [ In reply to ]
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I have never seen a PVC after each normal beat as a sustained thing. Or maybe I did when I worked in emerg that is becoming a distant memory. When you have a PVC after a normal beat don't you have a compensatory pause which would slow things down?. But I think you sell pacemakers etc so you would know better than I. And I am not a cardiologist. I agree HR can be tricky. Holter seems quite necessary in this case. The commonest thing I have seen in a non referral based population is a.fib or PAT.

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

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Re: Heart issues at CDA 70.3 run [len] [ In reply to ]
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len wrote:
I have never seen a PVC after each normal beat as a sustained thing. Or maybe I did when I worked in emerg that is becoming a distant memory. When you have a PVC after a normal beat don't you have a compensatory pause which would slow things down?. But I think you sell pacemakers etc so you would know better than I. And I am not a cardiologist. I agree HR can be tricky. Holter seems quite necessary in this case. The commonest thing I have seen in a non referral based population is a.fib or PAT.

I have seen it yes and go along for hours. I would assume eventually would put them on some beta blocker. Fwiw, you can have PVC with compensatory pause or not, just depends on the location of the PVC within the ventricles and the refractory period etc. Regardless people usually feel a PVC, while they can be in AFIB and not notice a thing. I think the big thing is the AFIB is so common place that athletes always think it is AFIB but there are many others including the dreaded VT that from what I understand Greg Welch had an raced with during the race which I don't see as being sustainable.


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Re: Heart issues at CDA 70.3 run [Velocibuddha] [ In reply to ]
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Velocibuddha wrote:
Warbird wrote:
Velocibuddha wrote:

3) The period in your graph where the heart rate is especially high is probably a technical glitch. It looks like a glitch to me- comes on suddenly and disappears suddenly.
Why isn't it just a glitch?


That area on the OP's graph looks like most of my shorter attacks: HR suddenly jumps 30, 40, even as much as 165bpm, stays there for a few seconds to a few minutes, and then suddenly drops back down to the previous level.


Ok ......but that is also one of the way it looks when my heart rate monitor gives off a false reading.

The thing that I find suspicious about that segment is that we do not see other signs of stress. I would expect a dramatic loss of performance and a greater sensation of distress.

At least in my case, sometimes the only way I can tell whether I'm having an episode is that I can't feel my heart beat, and if I'm wearing it my HRM will show a higher rate. Other times, I do suddenly feel out of breath and tired. But often, there's no real effect on performance. I've managed to get Strava trophies while riding during an episode. The medications I'm on (especially the metoprolol) are slowing me down way more than the a-fib alone does...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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