Hi Slowtwitchers,
OK. Just so you know–I will be seeking a medical diagnosis (if this is what it is), however, I am just curious is anyone else has a condition such as this? I have had an echocardiogram a few years ago that showed enlarged left atrium but was told that there was nothing bothersome with the scan. I have a history of heart palpatations and have been told by physician that they are benign (maybe related to menopause?). However, recently I noticed my heart racing when I am just jogging and heart rate shooting up and then coming down upon recovery such as walking or stopping an activity. I looked up my symptoms and believe this is a possibility (the wonders on the internet…). I have been an endurance athlete for 25+ years and I thought maybe I am just lacking fitness, however, the super high heart rate persists. I did a sprint distance triathlon yesterday and felt it on-off throughout entire race (I realize it was a race though so a high heart rate is not uncommon during a race). Does anyone have familiarity with this? I am looking for some insight. TIA
I have no idea but I wish you the best in getting a diagnosis.
Any chance you have long covid? If so maybe that is related?
You need to be able to differentiate between your high HR due to exercise intensity and high HR due to a tachycardia episode. A tachycardia episode will likely be beyond your physiological max HR, by a strong margin.
What other symptoms do you have? Shortness of breath, chest pain, dizziness, ‘closing’ throat?
How can you prove the high HR? Chest strap, wrist watch or perception?
Can you get yourself a portable single-channel ECG device (50-100 USD) and record while it’s happening?
Palpitations are common and doctors don’t bother unless you reach a certain % threshold in a given time. You shouldn’t bother either. Enlarged left atrium is ok-ish as well.
Focus all your efforts on ventricular tachycardia piece. This is unfortunately deadly (20% in 2 years, if not treated).
Hi Dr. Tigerchik, No, I don’t believe I have long covid, but you never know!
OK. Thank you for the information. I will look into the portal ECG device. I have seen those. I do experience shortness of breath, a bit dizzy. I chalked it up to ‘lack of fitness’ like we all do but now it’s becoming troubling.
@Kat_Kong I had AVNRT, and a successful ablation to correct it. What @Michal_CH said is very true, AVNRT is generally a very sustained and very high heart rate. I was up to 260bpm and >230bpm for almost an hour. Nothing I could do would lower my heart rate, rest/breathing/vasovagal/etc. I did revert BEFORE I got cardioverted in the ambulance though! What you’re describing does not sound like AVNRT, though I’m not a cardiologist.
Everything Michal asked are great questions, how high was the BPM, how was it measured (chest strap vs wrist)? If in doubt go see a Cardio and get a stress test (which may not even catch AVNRT, but great for ruling other things out).
AVNRT is one of several re-entrant atrial dysthymias. What this means is that the rhythm originates in atrium, and the heart rate is transmitted to the ventricles. This is in distinction with ventricular tachycardia, which is a potentially lethal rhythm if it degenerates. The rhythm is typically precipitated by a premature beat which falls at just the right time in the cardiac cycle that a self-perpetuating rhythm sets up. As others have noticed, it typically has a very high rate, sometimes north of 200bpm. With this you may feel lightheaded or dizzy because the heart has very little time to fill, so each heart beat ejects only a little blood, resulting in low blood pressure or poor perfusion of your head. It typically has a very abrupt onset, and offset as well. It is susceptible to maneuvers that increase the tone of your vagal nerve (in charge of slowing your heart). These maneuvers are things like bearing down (valsalva), carotid massage (be very careful with this), and others. The more frequent you have this rhythm and the longer it goes, the harder and more resistant to conversion it becomes.
This type of condition is impossible to diagnose without an ECG that happens to catch it when it takes off. In most cases a multi-day ECG is necessary. These are pretty benign, you wear ECG leads and a device the size of a phone that records any symptoms. To formally and rigorously diagnose and treat it, an invasive catheter based electrophysiology study is done.
You need to contact a cardiologist, specifically an electrophysiologist to work this up. There are numerous other rhythm issues besides AVNRT that could be causing your symptoms.
Recovery from an EP study/ablation is pretty easy. I had one and was off trainig for 10days, no lifting anything heavy for 10days, and that’s it. No pain.
I was diagnosed with PSVT, had a successful ablation, there is lots of info here on it.
I kept getting odd high HR’s - >250-300, was running past a hospital on north side of chicago and wandered in and said i thought my HR was a bit high to the receptionist - they rolled their eyes when I said it was >300, asked for my wrist and then didnt even bother taking my name, just put me on a trolley and went stat.
I got a holter the next day from my PCP, results the end of the week, saw an electrophysiologist within a couple of weeks - they provided options, I chose ablation and ASAP - no sense waiting and the problem would not solve itself.
had it - apparently it took hours but i was off my face on drugs 
so I thought it lasted 10 mins, discharged same day, stayed at a friends and slept for more than20 hours, woke up and three weeks later did my first ever sport that shall not be named - in chicago - and met the man the legend and former owner of this site - it was nearly 25 years ago now…
I thought the same. I was getting older and had been an endurance athlete for 50+ years so thought I was just slowing down until I had a pre-op ekg for shoulder surgery and they discovered my atrial was fluttering at 300 /minute. As a result I was not getting the blood flow I needed during my workouts and it felt like I was running at 10,000 ft of altitude. My condition is low heart rate afib so I never know I am in Afib until unless I am super low on energy and I check my Kardia mobile device.
I didn’t like the nuisance of having to wear it, but the best thing the cardiologist did was have me wear a Holter monitor for a month. They can discover and treat your symptoms as a result. I kept track of my exercise activities during that time and was able to correlate it to their findings which they liked.
The major concern they have is blood clots developing if you are in Afib. There is a little appendage in the left atrial where the blood can get stuck when in afib and cause clots. They say these are really bad clots to develop so they can put you on thinners (not good for cyclists like me who crash) or implant a watchman device to fill the appendage.
Good luck with your journey. If nothing else it is great to have a baseline as we age.
I had an ablation to fix my SVT (AVNRT). I would have very brief bouts of 220bpm during my runs. The electrophysiologist said I can live with it if I want or I can do the ablation since it’s affecting my training and racing. I did the ablation 3 years ago and haven’t had a problem since. I was told that AVNRT is the easiest rhythm to ablate with a 90% success rate on one try. Compare that to atrial fibrillation where it can take numerous tries.
ETA: an enlarged left atrium can lead to atrial fibrillation. Your symptoms sound like they could be either SVT or Afib. They will most likely have you wear a temporary heart monitor for an extended period of time. Try to induce your symptoms while you are wearing it.
Source: echo tech, stress testing tech
Are you sure its not just Afib or Aflutter? This sounds like what I had. My heart would go into Afib when I was exercising. Even at what I thought was an easy pace, my HR would be 170s-190s in no time. If I walked, it would calm down again.
EyeRunMD. Never heard of Aflutter. That is exactly what it sounds like. Do you just live with it or did you get treatment? I can live with it if it’s a harmless nuisance, however, i don’t think it is…
Sorry, I should have said atrial flutter, instead of Aflutter. That was me being lazy. When mine first started, the ER thought I had Afib. When I saw the cardiologist, he said Afib as well. He gave me a medication called Flecainide to try and pharmacologically convert me back to NSR. It seemed to work (mostly) because the only time I would notice any heart irregularities was when I exercised. I had a Kardia device at home and it would read that I was back in NSR (normal sinus rhythm) but it didn’t seem right. So, I told my cardiologist about this and he did another EKG which showed I was in atrial flutter. Long story short, I ended up needing electric cardioversion. If, or when, that quits working then my next step would be an ablation (like others on here)
I truly wish you the best. With all the heart issues that seem to crop up in endurance sport, I often wonder about reliance on caffeine for performance as well as caffeine and alcohol for habitual use.
My personal view is that both should be drastically reduced or eliminated where possible. AVNRT Risk Reduction
If either of those are part of your regular lifestyle, it would seem to be a mistake to combine them with endurance excercise, which is also considered to be a contributing risk factor (but I do have my suspicion that much of that data is exacerbated and confounded by the multiple daily coffees and caffeine gels, etc. that so many endurance athletes rely on).
Yes. I have noticed a relationship between caffeine and the fluttering. I have decreased my consumption of caffeine and stopped using caffeinated gels after I noticed it occuring more with caffeine. I don’t consume very much alcohol. I agree with you that among endurance athletes there is a great deal of caffeine/alcohol use.
Rare caffeine for me. Usually only a Diet Coke if I’m working overnight. Otherwise no coffee anything else. I deliberately don’t use gels with caffeine.
As others have said there are many types of arrhythmias and palpitations (typically premature ventricular or atrial contractions) are quite distinct and are punctual even if in bigeminy or tri eg every other beat, every other 3, or couplets, triplets (2 PVC PAC or 3) back to back.
What you describe seems more along the lines of supraventrolicular tachycardia assuming your HR doesn’t shoot up way above normal. If it’s a 20-30 or so jump, it’s most likely some variation of SVT, which can have many different causes including stress. If it’s VTach then it’s more serious. Either way, you need to get a non internet dx, get an ECG, most likely a 7 day holter (new ones are very small and easy to deal with unlike the clunky ones of a few years ago), and an echocardiogram. Probably a good idea to get a full blood work to look at for instance thyroid function, electrolytes etc.
I’d start with a sports cardiologist or an electrophysiologist assuming your insurance allows you to go this route directly. May save a bit of time but not necessarily.
Finally, you’re far from alone. It’s VERY common in older endurance athletes. But it requires a real work up and dx.
Good luck!
Thanks everyone! I am scheduled for a stress test on a treadmill (little do they know that this test will require more than walking uphill for me to get mimic a workout…). Now, I really question the accuracy of a heart rate monitor. Not only the placement of it (below the heart area) but if it picks up the weird extra beats? I have also experienced running very hard last night and at a pace where my heart rate should be very high and the HRM registers 20-30 beats lower?! Even with a new battery in it. Thoughts?
A treadmill stress will max you out, don’t worry. Extra or delayed beats will show up on an ECG. The electrophysiologic subtleties about where in the heart they come from are sensitive to lead placement, but their existence will show up on even a crude ECG.