Bummer and glad he should recover.

I am late 50s and have had Covid 2x last 7 months. Mother died from afib at 63. So many questions but will ask just one.

Did he have Covid recently?

My husband is 54 years old. No covid the last 2.5 years that we are aware of... we have both tested negative via antigen and PCR on every test and in 2022 he has been testing 2x a week before going into the office. He did have a Moderna booster on May 23rd... we both did.

Well I'm no doctor, so take this for what it's worth, but in my limited cardiac experience (me w/afib, wife w/SVT and now pacemaker), that seems like an awfully aggressive option for a first time caller who cardioverted on his own. Be that as it may, from what I know these things can be sudden onset, or grow over time.

In my case, I went into Afib whilst literally sitting at my desk at the ripe old age of 43, having absolutely no prior symptoms. My wife on the other hand went through bouts of SVT off and on for close to 20 years.

The good news is that I can't imagine he won't be back to training soon enough. After getting through the initial recovery of the pacemaker, my wife has zero restrictions or limitations - and she is a personal trainer. Plus he gets the special line at the airport now, so there's that.

All the best to him, I'm sure it's a shock but I'm sure he'll be back at it good as ever.

Unfortunately, cardiac arrhythmias a real risk with long term high volume endurance training. Hope his cardiac function improves soon

Sorry to read about your husband's condition but I've belonged to this forum long enough to know that heart issues with endurance athletes are not uncommon. I've read on here many times where posters agree this isn't the healthiest sport and participation comes with risks. IMO it comes down to genetics; some get to be fast, some get to endure, but it's hard to get both traits. At 65 I train a lot but do few workouts that max my heartrate. I'm not fast but I've endured to where getting on the podium may mean just showing up for the race.

Sorry to hear about that. Ventricular Tachycardia is no joke. Interesting to hear his angiogram was normal. I would rather have a pacemaker/debrillator than take the chances of having another V-tach episode while swimming/biking all alone without one. I hope he recovers well!

-cardiac stress testing exercise physiologist

If he hasn’t had a COVID antibody test as part of the viral testing it is probably worth doing to rule out COVID as a possibility.

Saw your post about this elsewhere and feel terrible for you guys:(

I have a number of patients who had been quite active and ultimately were diagnosed with VT and DCM (dilated cardiomyopathy) and required ICD placement to protect against future events. Sudden death is often the endpoint for prolonged VT (sustained by definition is >30sec), so when it's found, looking at the heart for structural issues-especially weakening muscle function or clogged arteries (*but also valve issues, thickened muscle/infiltrative CM and other issues like genetic arrhythmias from channelopathies etc.)

His echo and MR showed LV weakness and dilation-not thickness, so it's not ARVD or HCM. Cardiomyopathy is most often from CAD but when the angiogram is clean, it is labelled 'non-ischemic' or idiopathic cardiomyopathy. This is most often from a virus. There are many, many viruses which cause it-many more than just covid. An extensive viral workup is usually not done.


Hopefully with time/meds, the heart will recover and he will be back to living a more normal life-better protected from SCD with the device. The risk going forward is lower, but still higher than the general population-ie those without DCM and documented sustained VT. Usual Rx includes 'guideline directed medical therapy' with certain medications proven to lower risk.

Ask the doctors more about activity limitations, as 3 months is extremely conservative.

I wish you both the best.

I can’t help you with regards to the heart problems but sorry you are going through this.

As the partner of someone who suffered a massive life changing episode I will offer one thing. Find time for yourself and look after yourself as well as your husband.

Good luck

I have to question this comment as it seems counterintuitive to the benefits of long term regular exercise. Are you citing something or speaking from anecdote?

VT is not associated with endurance training. Afib is...

Very different animals----I mean arrhythmias....



Endurance training does not put one at risk for DCM but DCM does put one at a risk for both VT and afib.

So a cardiologist would not imply causation when discussing endurance training and long term cardiac risk?

No
I would not.

Impy causation of a dilated cardiomyopathy with LV dysfunction from endurance training??

show me the data-



and we are not talking about an 'athlete's heart'-I have studied this condition my entire career

Could be a reason.

Cardiovascular Adverse Events Reported from COVID-19 Vaccines: A Study Based on WHO Database
https://www.ncbi.nlm.nih.gov/...articles/PMC8326931/

Sorry to hear about your husband's condition. I too just raced Hawaii 70.3 and had a good day. I had similar health setbacks in late 2020 when I was burning the candle on all ends. Training, work, house projects, daughter's marriage, etc..., and pounding the coffee and admittedly hitting the alcohol a bit hard as well. I tested positive for COVID yet didn't feel that bad and basically ignored telltale signs that things were not good for about 4 months. Ended up going to ER with racing HR and Afib. Two electro cardioversion attempts and still no bueno. Finally reset on its own 48 hours later. Cardiologist recommended a substantial cutback in exercise and some heart medications. Took potassium, tramadol and blood thinners for about 3 months. No MRI but all the other tests were done. Echo showed some minor issues with heart performance and holter monitor picked up all kinds of stuff. I was lucky to get an ablation May of '21 which was successful and have gradually returned to training and racing. Coffee intake is down to 1 cup a day and maybe 3 glasses of wine or beer a week. Am striving to remove unnecessary inflammation due to stress or anxiety -- being grateful instead of worrisome. Also trying to eat more healthy choices. I've stopped all meds except potassium. I've had a few minor episodes of SVT and generally accept these as part of the bargain of training and pushing a bit. The triathlon lifestyle is a coping mechanism for me and not being able to swim, bike or run just doesn't suit the quality of life I'm currently looking for. Lowering intensity and expected outcomes is a continued work in progress but one that I'm thankful to have struggles with.

All my research on arrythmias suggest good outcomes when they are spotted and treated early. Am hopeful that your husband can find a path forward that affords him the lifestyle he's seeking and that he'll find medical professionals who can assist in this pursuit.

Hello sfjab and All,

Sorry to hear of your heart issues ...

Did your husband get a Watchman?

Is he on Warfarin or similar?

Good luck with recovery ...

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Cheers, Neal

+1 mph Faster

It is clear that some clarification is needed, as many on this board are fuzzy on some of the subtleties of cardiac dysrythmias. The heart has 4 chambers, 2 atria and 2 ventricles. The atria prime the ventricle with blood prior to ejection (systole). The atria are prone to certain types of rythm issues (we are not going to discuss atrial flutter or supraventricular dysrythmias). Atrial fibrillation is extremely common, it can come and go (paroxysmal) or be permanent or chronic. When fibrillating (a-fib), the atrium just quivers and does not contract in a unified manner to provide the final bit of filling to ventricle just prior to ejection. For some people, this results in debilitating breathlessness and fatigue, others are largely asymptomatic. One of the risks of Afib is that since the atrium is no longer briskly contracting, blood can stagnate in some of the nooks and crannies. If sufficiently stagnant, it will coagulate into a clot. This could then get ejected into the ventricle, then travel onward to other organs, such as the brain causing a stroke, or the extremities, causing an occluded artery. For this reason, patients with Afib are often anti-coagulated with medications such as warfarin or others, or mechanical devices can be placed to occluded the left atrial appendage to prevent clot formation (watchman). Although sometimes the fibrillating atrium can periodically cause the ventricular rate to accelerate, Afib is generally reasonably well tolerated.

The ventricle, on the other hand, is a totally different beast. Ventricular dysrythmias are extremely serious and need to be addressed immediately as they can be life threatening. Ventricular fibrillation results in a quivering ventricle (just like the atrium), however the problem is that this results in no blood being ejected to the body. As you can imagine, this is rapidly lethal unless treated with electrical defibrillation (shock) [incidentally, this is something TV always gets wrong. Defribllation does NOT “restart” the heart]. Ventricular tachycardia is a rhythm where the ventricle takes over its own pace setting and beats all by itself without the atrium helping out. Some people can survive this for minutes to hours, or even days, however this is a dangerous rhythm that can degenerate into V-Fib (VF) and then to death. Because of this, it often needs to be treated electrically to restore a normal rhythm. Lots of things contribute to ventricular tachycardia, some are genetic, some are structural, some are acquired, some are infectious (viral), some result from scarring from a variety of causes, and some result from insufficient oxygen (ischemia). Certain patients are susceptible to flipping into VT on their own, and because the propensity of this rhythm to degenerate into VF, a preventative device needs to be placed internally which is called an ICD. Ventricular dysrythmias are not amenable to anti-coagulation, watchman devices, and need to be taken very seriously.

And this, is unfortunately, the trouble with the majority of opinions which are on this thread so far.
This person had VT, not AF or SVT. It is a completely different pathology, with different causes and as DTOCE points out, a completely different endpoint (ie sudden cardiac death).
Even as an MD myself, and a professor in my own area of expertise, I leave the armchair opinions to the high level experts such as DTOCE on this. His is the key opinion that should be listened to.
For anyone else wanting to provide their opinions as to what should be done in this situation, and for numerous other medical threads here on ST, tell us your qualifications and specialist experience first. Otherwise you do a disservice to those looking for proper genuine advice, and sometimes the advice provided is downright dangerous.
mattyboy: am not meaning to single you out sorry, I could have replied to any number of replies on this thread.

I am a 57 year old male who had a congenital bicuspid aortic valve replaced in March of 2021 so very different conditions but my ejection fraction had been in the low to mid 30's before surgery and then after. It took 8.5 long months of titration with heart meds to get me to a 49% Ejection Fraction. That was a very happy day for me as it released me from all training limitations.

My only advise is from a psychological perspective. It may be a very difficult adjustment period for him to go from intense training to a light walk. To go from Ironman training and the mind frame that entails to a max Heart rate of 110 BPM is not easy. My Cardiology team kept telling me to be patient. My mind didn't really know how to be patient and it was very frustrating. Cardiac Rehab may be helpful as they monitor you as you go through light workouts (my max BPM was 130 or 140 so I could at least get a half decent workout in) and they too kept preaching patience. I wish you both luck as you go through this journey.

Thanks for sharing your thoughts.

3 months of minimal activity has been recommended and we just scheduled some follow up visits (1 week, 2 weeks and 8 weeks) with the various members of his cardiac care team (cardiologist, EP) here in San Francisco. We will ask about re-evaluating the activity level recommendation but my husband is taking the rest/recovery recommendation very seriously and we're not looking to push any boundaries just so he can swim and ride a bike outdoors again... [aside: he has already been researching e-bikes LOL]

It has crossed my mind that we take his records and get a second opinion somewhere if we find that it is not a genetic factor that caused this (e.g. Stanford). However, as you mentioned, if viral then a full work up is not usually done and we may never know...

I also appreciate the responses to this post that have shared their personal experiences to return to "normal" life after a serious cardiac event. My husband and I have been active triathletes for over 20 years and swimming/ cycling and running has been an important part of our lifestyle so this has been quite a shock and comes with adjustments, particularly for him. Of course, at this point, I'm just happy he's still around as I'm acutely aware that this was a life-threatening event.

You're welcome. I try to pick and choose what to respond to here on ST but did feel this was important.

And second opinions are never a bad thing-although do come with a cost. I have frequently recommended them even to my patients when there are questions or concerns. It sometimes helps just to hear things from another expert in the field. We are actually lucky here at ST to have quite a number of medical doctors and other experts who will weigh in from time to time, several of which have responded to this thread.

eblackadder was very correct in differentiating differences between the common afib and uncommon, but serious VT. Re-reading that post might be useful.


Time will likely go by slowly initially for you both, but he is already in a good place being protected with the device. Optimizing meds and activities will come with time. Patience is not often something that athletes do well-haha.

Anyone who has gone through a serious medical event has difficulties in the beginning processing it all. It will get better.


If I can be of further help, LMK.

*edited to fix terrible typing...

Did you say he had a booster on 23 May and then raced on June 4 (12 days later).

This may explain part of it. The immune system is fighting after the booster. Exercising hard after these vaccinations is just like exercising while sick. I hope my answer is not the answer, but I was ultra conservative for 2 week after all three of my vaccines for this reason (and I think I pushed it too hard after my third one as I was not flattened by the vaccines and got too cocky).

No way I would take a Covid19 vaccine closer than 3 weeks before a race, just because of the entire immune system fight.

I think one must be careful to separate personal health beliefs from unproven/unknown science. In particular there is no specific evidence based guidance re: COVID vaccination and not being able to resume athletic activity though I could not find anything about whether strenuous activity is any different. It really is not the same as fighting an infection. Most people will not have an inflammatory reaction post vaccine though some certainly do. In fact, here is some evidence re: exercise actually boosts antibody response post flu/COVID vaccinations. However if one is having a side effect (eg fever, fatigue post vaccine) that suggests an inflammatory reaction then common sense would dictate that we listen to our bodies and not exercise which would be similar advice if we were acutely ill with an infection.

I also would not get a vaccine too close to a race only because I'd be so pissed to have paid money and not be able to race if I were unlucky enough to have a reaction, not that I would be putting myself at risk for a reaction.

I think one must be careful to separate personal health beliefs from unproven/unknown science. In particular there is no specific evidence based guidance re: COVID vaccination and not being able to resume athletic activity though I could not find anything about whether strenuous activity is any different. It really is not the same as fighting an infection. //

EXACTLY!!! I exercised super hard the day of and right after each of my 4 vaccinations. I had no adverse reactions, but of course like Dev here, that is my N=1..The science and for most "all" people, there is little to no reaction to the vaccine, and as you pointed out, if you have one, then treat it just like if you were beginning to feel sick. IT angers me that these rare anecdotal stories somehow become the "science" of the vaccine, and not the overwhelming actual evidence of the 100's of millions that have taken them.


And to the OP, my guess is you may have had something very similar to what I had. It was a virus that attacked my heart, and there are dozens of them that could be the culprits, so really hard to know if and which one. For me I was finally able to figure out that it was EBV, which is a common one with athletes. Lots of pros and top AG'ers get this one, and often never find out if that was the one. It's just that this virus sits in over 90% of the population, so just waits for us to run ourselves down, or race/train hard with a little illness, and it is opportunistic and takes hold. And there is no cure, just a long period of rest, often times years in some folks. He should at least get the antibody test for this, and there is a more direct test to see if there is a current infection, I think testing for the actual DNA of the virus..


Tell him there is light at the end of the tunnel, I have had my pacemaker for over 2 decades now, and still am able to compete at the highest levels of some sports. But there is a re learning of what is possible, so old mindsets have to be readjusted..

Sorry I should have said "if recovering from post vaccine adverse reaction". Better to take down time. While there may be no data, we have several centuries of common sense to say that if you are coming off a fever better back off. Maybe the data will catch up, maybe it won't. The data may never be there because there may not be enough people reporting back adverse affects and even then you have to define "adverse affect" which could be a very wide continuum.

Anyway, its a personal choice if we hammer hard after a fever whether illness generated or vaccine generated.

Just to be clear, there was no apparent adverse reaction to the vaccine booster for either my husband or I... we didn't feel great the afternoon/day after the booster but thereafter we were both back to feeling 100%. He felt great for the 12 days leading up to the event and the 10-11 days after the event.

Just wanted to check in to see how your husband is doing (more on the morale side than anything). All the best.

After my 3rd shot in early 2022, I've had issues with leg muscle pain and my ankles were dysfunctional (pain, swelling).
I worked on the ankles over a recent 10 day vacation and they are OK now, I can run on them without pain.

I raced a sprint in May and felt something in my chest final few K's of the run, also my jaw went a bit numb.

Yesterday's sprint race after I used a gel with caffeine I felt the chest thing again, so backed off my pace to near walking at times (29min 5k). My muscles aren't working right either, felt really tight.

I had Moderna.

---

Training Tweets: https://twitter.com/Jagersport_com
FM Sports: http://fluidmotionsports.com

Physically, he's stable and jumped back into working from home today. Mentally and emotionally, he's hanging in there... it's a game of patience for the next few weeks and months to see if the heart recovers.

I was hanging out with a friend yesterday at 70.3 Tremblant who I have raced with since 1985. The guy is a former pro, raced all over the world. We shared a room together at Kona 2013. He had a horrible race (for him) and 5 months after coming back from Kona, they got to the bottom of it, and he got his pacemaker. He has been living the last 7 years with it and has been racing pretty normally, but is not super interested in doing pointy end stuff. He rode the 250km up to Tremblant to cheer on friends but if you go ride with him you would never know he's "limited" to any degree. He's not particularly interested in racing, but he probably trains 20 hrs per week most weeks anyway and is enjoying the lifestyle.

Hi,
Very sorry to hear this happened to your husband.

My heart situation is different, I had a heart attack May, 2020 - - this after about 25 Ironman's, 8 Kona qualifications and 2 Kona podiums.

I am very glad I sought a sports cardiologist as her recommendations on what I could do were dramatically different from the cardiologist who did my stent placement. One year post heart attack, I raced an Ironman in May, June, and Oct. and lining up again this August.

Pro triathlete, Tim O'Donnell is also coming back from a heart attack (google on youtube). His sports cardiologist is Aaron Baggish at Mass General Hospital and Baggish is probably the most highly regarded in this area. His protege is at Cleveland Clinic and that is who I see. There are also probably other good ones. Yes, the psychological fear is real and they get that.

As an aside, I am female. More women die of heart disease every year than all cancers combined. I hope you take this as an opportunity to get checked as well.

All the very best and don't hesitate to reach out to any of us if we can be of some help.

Thanks so much for sharing your story. It's great to hear that you're back racing already and doing well.

I know Tim really well and so am very aware of his story. I plan to reach out to Tim at some point about his recovery but have been trying to do more research and really understand what happened with my husband first. Tim's case seems more similar to your case, both of which is distinct from my husband's case, at least from a causation perspective.

We're trying to do the genetic testing first (one thesis is demosplakin cardiomyopathy) so we know exactly the specific cardiology expertise we're seeking... if it's not genetic, we may need a cardiomyopathy expert or a sports cardiologist depending on what his next echocardiogram looks like.

I'm just trying to learn and understand as much as possible at this stage so I really appreciate you reaching out and sharing your experience.

I am also 54 and had a cardiac episode during a bike race in early May.

I felt chest discomfort and pulled out 120km into a 228km race...at the time I was second guessing myself that I was taking the easy option because the discomfort was not THAT bad (but it was constant). The pain got a LOT worse on the way to the hospital.

My cardiac troponin results were about 200x the upper limit so good thing I stopped racing!

I was airlifted from the regional hospital to one with a dedicated cardiac facility where I stayed for 4 days.

Angiogram and echocardiographs were clear...but MRI showed an area of scarring (which could not have been from the acute episode).

The scarring is still being investigated but my ECG returned to normal within days and has remained so.

I have had a tele-consult with a sports cardiologist who I am travelling interstate to see for more testing.

Essentially, the scarring (epicardial fibrosis) may be from prior (unknown) episode (in which case it is unlikely to progress) or may be the beginning of a genetic problem (which means it is more likely to progress, but slowly)....sarcoid ruled out by PET scan.

I still have an aim to get back to competing (not soon!)....but will be following doctors' orders.

I wish your husband (and you!) well.

None of this is fun but knowing we're not alone with these surprises certainly helps my perspective.

Like your husband I had won a my AG in several IMs and while in great shape and training suffered VT and almost croaked. I got an ICD. It was rt venticle for me, ARVD, and anything above mild short exercise is contraindicated. I was 50 at the time and had been competing since 6th grade, but giving it up cold turkey was way easier than you would think when you know the consequences.
Ignore all the advice on here except from the actual doctors and just listen to and obey to the doctor you trust. They know what they are doing.

I hope your husband is doing better, that's definitely scary for sure! I came across this video 5-6 months ago, and just wanted to share this with you. Very high level cyclist that ended up having some issues after his second vaccination. He's posted a handful of videos about his road to recovery if you search his youtube channel. You and your husband may want to watch this...

https://www.youtube.com/watch?v=H7inaTiDKaU

did you register to post only your vax denialism? if so, please moonwalk back out of this community. however, if you have other topics on which to post accretive to the collective knowledge of folks who read here, you're welcome to remain and i look forward to your inclusions.

---

Dan Empfield
aka Slowman

A bit aggressive response to my post, but ok. I've been browsing the forum for well over a decade (maybe since 2008ish?), for mostly cycling related info. I actually made an account recently because I planning on doing my first tri (at the young age of 41 lol) this spring, and had some tri specific questions. I'm a competitive cyclist and used to compete in swim events as well, just never got into running or multi-sport races.

If you watch the video I linked to, and you go back to their channel and watch some of their videos, you'll see that those two are not anti-vax at all, quite the opposite. They are simply curious as to how he developed a heart condition two weeks post-vaccination. You'll also see updates to this on this channel that offer hope to the OP's husband, as Kyle has been making steps to recovery and is back to riding again, which honestly is all I want for the OP's husband.

If my post was taken in any other way, it was not my intention.

Edit: The entire reason I even opened this post was because a family member recently had an ablation done (early 2020, pre-covid) likely from being a world class endurance athlete for 30+ years and still competing in his 50's, and I've had a few weird arrhythmia type symptoms myself that my cardiologist said likely were benign, but to keep an eye on. I had zero reason to believe this topic was in any way covid related until I read the post...

i had an ablation this year. after 4 covid vaccinations. i also have had afib for the past 15 years and it really started to get nasty immediately pre-covid. my ablation was pre-ordained in advance of my first covid vax. this is why i tend to question the nexus of an ablation and a vaccination. as you put it, having the pedal to the floor for 30 years as an endurance athlete is the proximate cause of a lot of afib.

this forum is 20+ years old, as you may know, so i have 20+ years of hearing about the moderation quality. the very first, very best, indicator of what a user's agenda is is his or her first post. had this been, say, your 150th post you wouldn't heard a peep out of me. that's why you got the "welcome" you did.

i will take you at your word, and again extend a welcome to you. my aggressive moderation (which is considered not nearly aggressive enough to a lot of users here - you can't win for losing) works in your favor as well, once you are a regular user here. i hope this community helps you achieve success in your first tri and i hope to see you out onthe race course. i look forward to your contributions and i'm at your service if i can help.

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Dan Empfield
aka Slowman

It's been just over 5 months since I posted about my husband's VT event and we may finally have a diagnosis. After getting frustrated with the cardiology team in San Francisco, we sought out a second opinion from the cardiology team at Stanford. The Stanford team have been much more intellectually curious about why this happened to my husband as well as giving him more rigorous (data-driven) parameters around activity going forward (eg stress EKG).

As part of their testing, he underwent a PET scan last week which showed that there was still inflammation in the heart, The diagnosis is cardiac sarcoidosis and he is now starting a treatment course (prednisone/methotrexate) to get the inflammation under control. He will have another scan in mid-January.

While, the diagnosis isn't great, there is at least a treatment plan which we hope will help. In addition, he's been feeling fine and was back to swimming and riding his bike (sub-120bpm heart rate) until he crashed and broke his collarbone (right before the PET scan)!

I'm guessing the answer is "no" but let me know if anyone else out there has been diagnosed with cardiac sarcoidosis and what level of activity you've been able to resume post-treatment.

Thanks!

Hey Dan, I am not anti vax as I just had my 4th 22.5 hrs ago. But I don't think we have enough data out there to really know if extreme endurance exercise in the proximity of vaccines has no impact on heart health. My common sense filter suggest that any time the immune system is in fight is not a particularly good time for hard exercise. I think putting vaccines aside we all have enough sample points from 40 something years of various extreme endurance racing in the proximity to sicknesses to know it generally is not an awesome idea. I don't think we have a full correlation established yet for C19 vaccines, simply because the number of people doing really hard endurance feats close to vaccines was not measured by the pharma companies. Maybe there is zero impact

So for myself at a personal level, what I do if I have some levels of sickness or fever is back it off for a while. At least the intensity and certain intensity x volume.

Whether there is hard quantitative evidence that vaccines coupled with hard endurance coupled with heart issues are all co related or not, I am not personally willing to find out on myself, but eventually I hope that we are willing to all see if there is or not in a quantified manner. I don't think we are in the clear data wise to know if you can take vaccines and hammer out hard 70.3's a few weeks later with no additional risk than if you hadn't taken one.

For the record, cardiac sarcoidosis, although a type of ‘inflammatory disease, has nothing whatsoever to do with vaccines/Covid

Ironic that my final patient follow up Wednesday was someone I met earlier this year with complete heart block and ultimately we were able to figure out she had cardiac and pulmonary sarcoidosis

Now perfectly protected with her icd and steroids