AHS is not really a symptomatic disease, it's a physiologic adaptation to endurance training that causes a low resting heart rate and high beat-to-beat variability due to elevated parasympathetic tone. It does not cause a true arrythmia because conduction follows the normal pathways through the heart. I can't second guess your physician not having seen your EKG etc but if you had actual abnormal patterns on the EKG - "strange routes across the heart" - and a subjective sensation of irregular beats you were more likely to have had a benign arrythmia like premature ventricular or atrial contractions (PVCs or PACs respectively)

I was incidentally diagnosed with AHS by EKG criteria; I would venture to guess that most of the posters in this forum would have similar findings if you gave them all an EKG

Me.

Avoid caffeine. Ease up on training volume. Voila.

Buzzkill.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Don't discount the psychosomatic effect, especially when you're a bit stressed out. I avoid too much alcohol and sugar - caffeine doesn't bring on the rolling beats for me.

Like you, I've had all the tests.

talk about buzz kill

I have exercise induced asthma, and I have several of the heart issues you mention, but I've never been told it's exercise related.

I have ectopic beats, arrythmia and tachycardia. After almost 6 years of testing, there doesn't seem to be anything in my case, that appears to be even suspected as a cause. Any or all of my heart issues can happen at any time, and at any rate of exercise from sleeping to balls out sprinting up a hill. Nothing seems to make any difference. If I was at all religious, I'd be tempted to say it's "Gods Will" as that's about the only option left. :-)

After being concerned about it for years (not stressing, just being aware of the potential end game) I now don't bother about it at all. I just do what I want and let the chips (if any) fall where they may. I do generally train and race with a HRM however, and I do heed my cardiologists advise to back off, sit down, or lie down, when I get to 200BPM, but he says everyone should do that, not just me.

After 7 Ironmans and multiple half's I'm now skewing to start a foray into ultra marathon. I figure if I can even contemplate such things, then my heart issues aren't worth worrying about. As my boss says "Life is little more than a sexually transmitted terminal disease" (ie we all die eventually) and to quote myself (to my cardiologist) "If I die, all my problems are over"

In short, take care, but don't be narcisistic about it. Race and enjoy it.

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TriDork

"Happiness is a myth. All you can hope for is to get laid once in a while, drunk once in a while and to eat chocolate every day"

Unfortunately I have become somewhat of an expert in this area. As a group, top endurance athletes are way more likely to have heart anomolies than the general population. It appears that there is some confluence of events that brings out the anomoly, and once triggered, it seems to become more likley in the future. What i have found is that there are many such triggers, you identifyied two of them, caffine and alchol. There are many others, low, magnesium, sodium, postasium, bad or too short sleep, physical and mental stress, and the one that is most probably getting you right now, being anxious about the situation. My doc told me it is normal for athletes to have between 100 and 200 PVC's a day, we usually miss feeling most of them. But when you become hyper aware of your heart, like you are now, you begin to notice every one of them, and get anxious about it. Than state of mind leads to having more of them, because now the mental stress has become a factor..And over time it just gets worse and worse, but you can mitigate and prolong any radical treatments by controlling the triggers..

So I suggest you get some very detailed blood work done, especially during a time when it seem like you are having a lot of these occurences. I know it is very hard to just try and relax, I could not do it without anti depressents, but they helped me almost immediately in that area. My biggest triggers were the low magnesium and sodium, and the biggest was my sleep habits. I have a very hard time sleeping through the nite, and even when i do , it is not great dream sleep. I had cut out all caffeine, but have been able to add it back in very small amounts(two 1/2 caf cups in the morning). No more heavy drinking, but once in awhile some beer or red wine, wine seems to be better. My aniexety is in check, but it can go up and down..

I suggest you do all you can to figure out what it is that triggers you. Like you, it happens mostly in the resting/lower heart rates for me. Once up and running, I'm good to go. When I left the hospital 10 years ago, I was being paced 35% of my life. By paying attention to all these things, it is currently down to 1%. I'm told over time it will degrade, but starting at 1% vs 35% gives me a lot more breathing room, and time for technology to catch up with these mystery heart defects we inherit through our love of sport..

I have been having the same things going on and, like someone else said, the more anxious one is about it the worse it gets. Most of my problems seem to be caused by, of all things, GERD. Apparently 'stuff' flows upward and triggers all kinds of heart beat anomalies which lead to all kinds of stress related responses which have sent me to the emergency room on more than one occasion. All the EKGs, Stress Tests, and ECGs confirmed my heart is fine, however, when stuff starts gurgling, and my heart skips a beat, it sure leads to some interesting feelings...

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I know enough to know I don't know enough...

My friend had similar symptoms but was also coupled with high blood pressure and his physician said to try Co-enzyme Q10 cut out caffeine alcohol etc. and it seemed to have helped.

I have episodes of PVCs. Stress, lack of sleep, too much sugar and alcohol bring on the PVCs for me. Fortunately, caffeine alone doesn't seem to bother me. However, caffeine along with alcohol and sugar can pretty much keep me up all night they get so bad. Than they will continue for days until I catch up on the sleep I've missed. Pretty much stopped drinking because of it.

Monty, glad you are running well and on top of your heart problems. I have found from scans etc the cause of my afib is mitral valve regurgitation. Cardio guy insisted I take warfarin to thin the blood to prevent stroke, but after an internet search of the side effects, I refused to take it and also refused aspirin as well. That was 12 months ago. I instead used natural products like fish oil, ginko, ginger etc.. I discovered how good vitamin k2 is for the heart by removing calcium deposits from the arteries and depositing it into the bones and making them stronger.
Visited cardiologist this week after 6 monthly visits and the heart must have improved as he does not want to see me for 12 months.
I am cycling well and can easily get my heart rate to 200 on hills but it drops 50 or 60 bpm within 1 minute on the descent, so I figure things can't be too bad.
I will be 72 next august btw

I've had some of the same things, in my case it's a sign that I am extremely dehydrated.

John

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Top notch coaching: Francois and Accelerate3 | Follow on Twitter: LifetimeAthlete |

Thanks everyone for the great responses. Glad to know I'm not alone and/or imaging it all. The PVCs seem to have quieted down today, so I hope it was mostly a stress trigger this time around.

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Trieatalot

It's a C minus world.

I've had PVC's since my 30's. When I was 39 I had an exercise stress test and was told it was common in distance runners. Back in those days I had very very low resting heart rates and even now my morning resting heart rate can hit 37. Last year I had a thallium stress test at the VA and the cardio opined I had a normal ekg with no PVCs evident during that test. (I'd asked them to check for them.) Two ekgs previously had picked up PVCs. Since I've had this "condition" for at least 30 years, I'd say it doesn't appear to be killing ME. YMMV. ;) By the way, I average about 6 cups of coffee per day.

Is there reason to believe this condition will kill you? Have you had a Holter Monitor study done? (I had this done about 6 years ago.) Do you have mitral valve prolapse as well?

-Robert

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"How wonderful it is that nobody need wait a single moment before starting to improve the world." ~Anne Frank

I personally do not have AHS, but it seems that it could just be mistaken with a normal irregular heart beat. A vast percentage of the population has some degree of an irregular heart beat. Be it from an electrical conductivity pathway misfire or from a "leaky" valve or prolapse, many people go their entire lives without ever noticing that it exists. The problem for us, being over active athletes, is that we tend to notice the little hiccups more than "normal" people. We push the boundaries of our muscles (and the heart is just that, albeit a very important muscle), so a minor, or insignificant, misfire for one can be a terrible inconvenience for another.

That being said, I think, as someone else pointed out, that it could also, and more likely, be due to an electrolyte imbalance. Our heart is controlled at the cellular level by only a few electrolytes (sodium, potassium, magnesium, calcium, and chloride). Those electrolytes need to be properly balanced or your heart will have an electrical stimulus misconducted (or irregular beat, i.e. PVC, PAC, PJC, etc.), which could be what your are noticing. Being the over training, over active athletes that we are, if we don't have proper nutrition and hydration, this could be exacerbated and take physiological effect in the heart. Another reason for the early beats could be the chemical stimuli such as the caffeine, energy drinks, and gels that we take. But then again, I'm just guessing, and I'm not a cardiologist.

But you stayed at a Holiday Inn Express last night ;-)

what concerned you about the aspirin? I ask because I'll be on my way upstairs soon to take my nightly 81mg.

And FWIW, a new drug was recently approved for use in the U.S. in lieu of warfarin. It has fewer side effects and doesn't require the periodic blood testing. I can't remember the name right now (pradaxa maybe?). You seem content with no drugs right now, but if that changes you might want to look into the newer alternative.

yes it is Pradaxa, started it 3 weeks before I had A-fib ablation which was 3 weeks ago and supposed to continue on it for at least
another 6-8 wks I think
Somebody mentioned being hyper-aware of your heart after going through this and wow is that ever true - realize now I had flutter and A-fib for (ever) yrs ??
couple episodes of heartbeat up over 190 for more than an hour and staying high (130's for 5-8 hrs) finally lead me,
(with forceful push from the wife cause she was aware of 3-4 episodes in a month) to go through all the tests (stress, MRI, MRA, Cat)

I'm 55 now and been given the okay to start back exercising - interesting to me that my "resting" heartrate is 25 beats or so higher right now
though my exercise heart rate stays realtively in same ranges as before

wow, 25 bpm is a big increase. I would expect some due to detraining, but not that much. Best wishes for a "quiet" heart post-procedure. I had a-flutter ablation about 6 months ago, and all quiet so far.

I think that is what one of my friends had. Had to have two surgeries, and his HR was up to 140 without stressful activities.

Recovered and doing first IM tomorrow

I found a great article on the side effects of aspirin on www.drjameshowenstinearchives.com which influenced me to go with natural products. Also, you will find his article on vitamin k2 on that site which is really worth reading.

Also, there is info if you do a search on www.vitamincfoundation.com for aspirin. I just had a look there to refresh my memory and it mentions l arginine is a better alternative than aspirin..
That site follows Linus Pauling's teachings and that is all heart disease is caused by low vitamin c intake and that all heart disease is a form of scurvy Pauling won a nobel prize for his research into vitamin c back in the nineties but his findings have never been promoted by the medical profession and there is no money in vitamins for the drug companies as they cannot patent them etc.

I also take magnesium, a mega tablet am and magnesium chloride powder mixed in water pm. Only a small amount of powder is needed as too much will give you the runs the next day.
Pradaxa has just been released here in Australia this week and I googled the side effects of that too, and they are not good

The problem with Pradaxa from an athletic POV, is that there isn't a readily available antidote to its anti-coagulation properties like there is with Coumadin/Wafarin. Meaning that if you get hit while riding/crash, the chances of severe/sustained bleeding is much higher than with Coumadin. TT your Dr about this before making your decision.

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"There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs." John Rogers