afib or svt could be possibilities..


I have dealt with svt for 10 years and continue to do so, but mostly ignore it now after failed ablation attempt. with svt my hr jumps up and I can always tell when it is happening but I find it does not limit me as much as I initially thought it would. it did impact my ability to do mass start events like crits and road races because it did reduce my power output until I reset it at which point to group would be up the road. afib...another beast, no power ability, heart not pumping properly and for me it was likely due to undelying condition.(torn valve) afib also resulted in elevated RHR, while svt did not.

probably need the prolonged wearing of holter monitor for docs to catch it and identify.

bottom line, doc visit definitely in order to determine what you are having

Definitely get it checked. You can also get one of those Kardia monitors to track it at home, and maybe catch an episode. Murphy's law indicates you will have an episode the day after you return the Holter.

x2. Suggest visiting your primary care physician. Could be one of many different things triggering your HR spikes. You may end up wearing a Holter monitor for several days or perhaps a couple of weeks as the previous poster said.

In my case - age 63, height 6 ft even, wt mid 160s in season. Have been doing mostly oly dist tri's since 2012 (no races prior to that) and dropped alot of weight in the process. A couple of years ago my HR monitor started occasionally picking up unusual, rapid spikes - some of which exceeded 200 bpm. Happened only during races and workouts when HR>135 bpm. No symptoms, no adverse power impact and resolved on their own within a few minutes. At first I thought it was a problem with the HR monitor but one day was on stationary bike when it happened. Took pulse manually and it confirmed what monitor said.

Early last year they began to occur with greater frequency so decided to see my internist. He ordered up several tests including Holter monitor. No "plumbing" issues but the monitor picked up several svt's so he referred me to an electrophysiologist. Was diagnosed with paroxysmal atrial tachycardia last spring. In my case also, RF ablation unfortunately did not resolve the issue. During a follow-up consult the EP said given the proximity of the "hot spot" to the AV node a second ablation procedure would be too risky. He prescribed a low dose beta blocker to slow my HR. For those of you who have been on beta blockers, this is not what an endurance athlete wants to hear. So for now it's no speed work, just alot of low intensity stuff until I can get a second opinion.

Hope all goes well for you. See a doctor about this and pls let us know the outcome.

Are you freaked out about the virus? Were there other symptoms the first time it happened or could it have been an equipment
problem like a bad strap?

I had episodes of PSVT about 7 years ago. Would be sitting at computer, heart rate about 60 bpm, would raise my arms above my head to stretch (one of the triggers) and heart rate would jump to 150-160. After about 20 seconds, would jump back to 60. No ramp up or down, just jump from one rate to another. When talking to my doctor, it did it in his office, he said at least it is a steady pulse (no afib). Did the Holter monitor, and other tests. A friend mentioned that her brother had something like this, and he took a sublingual B-12 vitamin and a magnesium supplement called Slo-Mag. I started this, and over the course of a week the symptoms reduced, and finally went away. When I went to my doctor for follow up, his recommendations were beta blockers, pacemaker, or could try ablation. Since the problem had disappeared, I didn't do any of that, just continued with the supplements.

Have had two recurrences since then. The one time I just upped the magnesium dosage for a week and all was well. The other time was about a year ago, when I had a mysterious bug. Thought it might have been the flu, but main symptom was fatigue, negligible respiratory symptoms. This time the jump in heart rate wasn't steady, more like an afib. I upped the magnesium dosage, and made sure not to take the magnesium with coffee. (Caffiene inhibits absorption.) It took a couple of months, but the symptoms went away again. No problems since.

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salmon - not because I'm a fish

As a guy formerly gone through a couple rounds of afib at 44 (since corrected via ablation), I can only second this part. I am VERY tolerant of most drugs, but those things knocked me on my ass.

Just to add something not so serious... Sometimes the body is complicated and does weird stuff, but isn't always bad. It sounds like its possible you may have triggered your vagus nerve going #2. The vagus nerve controls HR, breathing, and upper GI tract. If during your (hopefully satisfying) poo that the nerve was overstimulated (maybe bearing down, which drops your HR). An increase in HR or even palpitations, and/or increased blood pressure to balance the drop in HR from bearing down, followed by standing up, which can last for a few minutes. Then you focusing on your HR after maybe kept it a little high... But laying down and breathing easy was good.

Quite a few "normal" actions (bearing down, jumping into cold water, coughing, holding your breath forcefully while exercising) can cause seemingly random changes in HR, and can even make things go a little wacky with the heart like palpitations (but sometimes straighten things out). The cough reflex also uses the vagal nerve, so a good cough or two can sometimes interrupt and and reset the heart from non-chronic palpitations. All these things are generally normal, and not necessarily indicative of a defect or illness. But with that said, I'm not a doctor, so theres no harm in getting it checked.

Good luck and hope it's nothing serious.

Best

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Matt Leu, M.S. Kinesiology
San Pedro Fit Works, Los Angeles, CA
Endurance Athlete and Coach
Consistency/time=results

Many thanks to all of the responses and the PM. Really appreciate them.

I actually did end up going to the ER on that day. The deciding factor was that I felt pressure around my heart for 45 minutes after the episode and wanted to rule out anything immediate. The pressure also did eventually ease off; probably just psychosomatic. Based off of the helpful answers, I mentioned the two possible conditions I'm concerned about, but the ER doc basically stated that it's not possible to make a determination at that time.

They did an EKG, chest X-ray, and bloodworks. They ruled out heart attack, which is nice. Final diagnosis was palpitations, but I'm definitely going to look into this a bit more. Even before this, I was planning on going to my primary care on Monday (would have been the day after the episode), after reading about the many cardio-related scares endurance athletes have. Though that appointment is now cancelled, I'm hoping to see a cardiologist, if possible.

The only less-than-satisfactory thing about all this is that I was told to come back to the ER if another similar episode were to occur before I get to see a cardiologist. Something about it feels slightly kafkaesque...

Thanks again to everyone!


Thank you. I'm hoping that it's nothing more than what you described.

I've taken to wearing a HRM and recording HR while going to the loo. Yesterday, HR was ~50 before going (while sitting at my desk), and it peaked it ~85-90 while I went. It came down a bit more while I was washing my hands. From purely a fluid dynamic perspective, I'm wondering what the requisite blood pressure drop would have been in order to have the HR spike to 3-3.5x resting HR. From some of the charts I've seen, one could easily experience a doubling in HR when performing a Valsalva manuver, with a corresponding ~33% reduction in systolic pressure.

PM me of you want more info. Had ablation. I had to try to drugs first for insurance purposes and my doctor all but told me to throw them in the garbage and then we would do the ablation. Those drugs suck. Was 43 at the time, had my best races since then. KQ 3x. The surgery is a drag but not for long, and the docs and equipment are way better than just 5 years ago.

Quit drinking if you have not already.

And I have had another episode today, this time coming at the end of a bike ride.

The plan of the day was sweetspot work, with power increased 10 watts every 10 minutes, and with the first hour or so fasted. I've done quite a few fasted rides (albeit generally at lower intensity, say ~75% of AP), while today's ride started at ~73% AP and ended at around 91% AP. Though HR seemed slightly high, nothing was amiss during the ride. After 60 minutes, I also ate a Clif Bar (first calories of the day, right around noon time), and the rest of the ride was fine.

After riding for 75 minutes, I spent the next 5 minutes basically at low Z2 and rode over to my LBS. Right after I dismounted and was turning off my on-bike cameras, I felt my heart pounding. And then it got more intense. I was still in range of my Garmin, and it showed HR of 205. This is quite concerning, as I rarely see HR above 185 these days. I immediately sat down, and it was still hovering above 195. I next reclined on a bench, and my HR finally began to dip. After five minutes or so, it was now low enough (although still relatively high at ~75) that I could go into the shop. I was then able to ride home. Right now, as I sit to type this, I'm at ~60.

Because of Covid, I basically wasn't able to see a cardiologist immediately after my last episode, and I've almost forgotten about it afterwards, but getting something like this again makes me think I should really check this out. Based on what I wrote above, anyone has additional suggestions on what to look into? Many thanks in advance.

Def see a specialist, sounds a lot like the SVT which I have experienced for about 8 years now (first time I was at about 220 for close to an hour) my doctor was very reassuring (once I had some imaging of my heart done) that it was not something that serious despite it being pretty terrifying. I opted to not get an ablation, it has only ever happened to me on the bike and I chose to pretty much quit v. high intensity riding/racing. They will also usually give you some things you can do should you have an episode to help make it subside (laying down is one of them, cold water on the face, 'bearing down') which have been effective.

Either way, see a doctor who will most likely give you peace of mind, and you can then check in periodically should you have any issues.

Also, fwiw when I switched allergy medications I started to get fewer episodes, could be unrelated by my doctor had said that the one I was taking was fairly well known for causing some HR issues.

what Ollie said - see a specialist.
she/he/they will give you a heart rate recording device to get more data (by recording an episode).
that data should help drive the solution - like Ollie i had an ablation - for me it was in the WAY back days of 2001.
it seems to have done the trick for me but the specialist will have the best advice if the ablation is the best for you.

pretty sure Ulissi and Stybar have recently dealt with something similar - others are and have encountered symptoms you outlined and there are ways of dealing with it. get it checked! sincerely, rick norton

Thank you both for your suggestion. I'll definitely bring this up when I see a specialist. Unfortunately, I called the local cardiology practice (affiliated with UW), and I've been getting cold shoulders so far. Hoping that I can get an appointment in the near future.

The speciality that may be more appropriate is an electrophysiologist although you may have to see a cardiologist first. PVCs are something you can definitely feel as it is essentially a forceful contraction that is out of timing with your normal heart beat flow as the contraction starts from the ventricles (bottom part of heart). SVT/AFib/Aflutter is more of a normal pattern as the electrical flow starts from the top (atrium), where it normally starts and conducts down to the bottom. You may also feel it but the feeling should be different. More of racing feeling. You generally don't have a lot of PVCs in a row (would be racing as well) because if you do it is generally Vtach and Vtach can quickly turn deadly quickly. You more than likely have SVT/Aflutter going on but there are lots of possibilities and other rhythms. One thing I would be curious is if you had coffee this morning or any caffeine. Any increased stress levels in general lately as well.

Again, I'm not a doctor but was a pacemaker defib rep.

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access to a hospital attached to a university ? Teaching schools are great for getting looked at, not sure in the current state if there is a hold up there

most definitely you'll wear a halter monitor, probably for a week. you will prompted to call the halter company if/after experiencing an episode.
Probably an MRI with contrast. Smart phones ekg with attachment and app may also be used
might be put on a blood thinner after initial review of monitor while mri and is scheduled and what direction to go with prognosis

I was early/mid fifties when I had episodes, resting heart rate in morning was 28-32; sitting on couch 38-42, walking around house 48-52 or so

all of the above by cardio Dr at UofUtah (allegedly one of the best and we clicked) - one and done and been good; resting heart rate is quite high compared to mid 50's but I'm 65 now

pm if I can answer anything more

Thanks for your comments, @heyMartin and @Thomas Gerlach.

The cardiologist will be most certainly be affiliated with the teaching hospital, so hopefully s/he would be more knowledgeable. The hope is that given that this is Madison, the person seeing me either understands endurance athletes or is one him/herself. Unfortunately, I'll have to wait for almost three months before I can be seen.

I did drink coffee yesterday (and probably did so when this first occurred last year). My routine is a double espresso when I wake up, and these days, unless I really need to do a hard work out, my first calories are ~noon time (or one hour into a work out). Not really under much stress, though I am finally able to ride a bit more, and perhaps that additional riding was additional stress?

I would hope that the Halter monitor would capture something, but chances are (and as alluded upthread), it won't capture anything of interest while I'm wearing it. Oh well.

I was told that the monitors don’t have to actually capture an episode for them to get useful info, not sure if that’s true
Of course they put me through a stress test and Blam, I went into flutter and afib. They were so excited !!! Giddy - gave me a shot of something to slow me down with

Hope you get a vacancy to get seen earlier. All the best

As noted above last year. You can get a Kardia. Dtoce has recommended it in other threads, as has my cardiologist. It works with an app on your phone, and takes an EKG. They have a 1L and a 6L version. I got the 6L. You can create a pdf and mail it to your Dr. if you capture something before your visit. It does some limited automated analyses for detectable arythmias.

Last year, post heart-surgery, I wore a 30-day monitor, which came with a dedicated cell-phone and uploaded data in real-time. My cardiologist sold me on that one based on a) the length of the observation period, b) the real-time collection. With most Holter monitors, you wear it for 7 days....then they download the data, and review it "after the fact"....which may take a couple of weeks for results. So, any "events" are weeks old, rather than hours or a day.

The Kardia you can buy from amazon, and carry it in your pocket. Any of the monitors requires a prior doctor visit, diagnosis, and a prescription. The Kardia may help get the diagnosis before ever even resorting to a monitor.

Good luck. Kick in the door if you have to. But don’t get your hr up.........:)

Another that had an ablation to handle SVT and still dealing with high number of PVCs. Last recording bit was about 8k per day (for reference that isnt good but over 20k is dangerous - so they say) and working through what is next. The recording devices have really come along. You may be able to convince to them over the phone to let you get a ZIO monitor. Basically glues on for 2 weeks (although both times I got about 10 days out of it) and data is uploaded via an app for them. Was much nicer than a halter and less intrusive then an internal recording device although those are much smaller now as well.

Great book called The Haywire Heart out there as well by Mandrola etc and Mandrolas blog is worth reading

Sadly know more than I had ever hoped about it and the system so hit me offline if you like.

Good luck

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Banger

I'll add to the everyone - see a cardiologist and get it sorted.

Both my brother and father have had the AV node ablation which worked brilliantly for them (cured the tachy) but they also have AFib - there's some great genes in the family mix, but heart is not one of them!

It's made a huge difference for both of them, along with some lifestyle changes to reduce stress - reducing insane work hours, more exercise etc, but you sound pretty much on top there.

Thanks to everyone for chiming in.

Also, I didn't quite realize that the "Kardia" mentioned up top is a portable monitoring device. Certainly looking to get one now.

Unfortunately, appointments are pretty booked, until at least early October; so quite a bit of sit and wait in the mean time.

The points about stress is well-taken, and something I will work to reduce.

In the mean time, I'll probably get a copy of the Haywire Heart. Heard of it when it came out a few years ago; didn't realize that it may be personally applicable.

Yeah, its tiny. Just barely big enough, frankly. Like 1" x 3" x 0.25" (2.5cm x7cm, x 6mm), and weighs maybe an ounce (28g)?

I keep thinking I'm going to lose it. They need to add a buzzer to it, and embed "find my" or "where's my" tech into the thing. I'm forever leaving it in a pants pocket or my gym/work bag, or on my dresser, coffee table, etc. Kinda like my keys and wallet.