I have been doing triathlons for over three years now and have been slowly getting my weight down to the point where I am only “over weight” instead of obese. Mid-way through my first season of training two years ago I started to occasionally develop chest pain while running. It would happen when I was trying to run hard and my heart rate would only go up to a certain point. My max HR is 185 but my pulse would only go up to about 130 or so and then no further. I would then start to feel chest pressure like I couldn’t breath and would be forced to slow or stop. The pain would go away immediately, but if I started to run again it would come back at the same HR.
This happened a handful of times and I had an EKG done and a stress test and they both came back negative. I notice from my training logs that the events seemed to be preceded by particularly hard training sessions and relatively restricted calorie consumption in the days leading up to it. So I started keeping close track of my calories and not letting my self get into to much of a deficient and have not had any further incidents of this type for over two years in which I have done numerous triathlons, running races and a marathon. Because I couldn’t get my HMO to cover it and because I stopped having the problem I never saw a cardiologist about it.
Now, tow years later I am training for another marathon and I am experiencing the same phenomena again. I have been a bit more restrictive in the calories to get my weight down, but the other day I even had an event after basically binging all weekend. I have a referral to a cardiologist who I will see in a few days (yea! new insurance), but I want to be armed with as much information as possible, because I expect he will just tell me to stop running. I have scoured the internet for any information on what this could be and have come up with nothing. If anyone has experienced this or heard of anything like this before I would appreciate any info you might have. Thanks!
When you say that your max HR is 185 but your pulse only gets up to 130, what do you mean?
If your HRM says you are at 185, but you only count 130 down at your wrist, there’s a good chance that you are having a good bout of PVC’s, Premature Ventricular Contractions. Not such a good thing, but there are certainly worse things…
When you had a “negative” test prior, was it because you didn’t have any angina (chest pain) or because they didn’t see any irregular rate / conductions.
Do you happen to have an EKG strip from your previous exercise test?
A good indicator of cardiac stress is the Rate Pressure Product (systolic BP x HR). This multiplies the external resistance (SBP) by the intensity of beating (HR) to describe the stress the heart is under.
I would doubt that your cardiologist would tell you to stop running, but if they find something they will suggest an intensity limitation… which is a good thing. Sometimes life gives us lemons. you don’t go to fridge and get some OJ, you work with what you have and make lemonade. Same thing with training with heart issues. This is what you have to work with, do you best with it.
I work in cardiac rehab and can tell you that activity is one of the best things for your heart. The right kind of activity is important though.
I work in Cardiac Rehab, too (10 years)and you should know HRM’s won’t register PVC’s. No one knows how quickly Heart Disease can progress, but I have seen patients arteries clog much quicker than 2 years. Go see your Cardiologist, request a stress test or angiogram. Angio is the only definitive way to guage whether or not blockage is present. PM me if you want more info. R.J.
When you say that your max HR is 185 but your pulse only gets up to 130, what do you mean?
I regularly test my max and threshold heart rate to set up my training zones. For running my max is 185 and my threshold is 156. My resting rate is 54. What I mean when I say that my pulse only gets up to 130 is that on the occasions when I have these chest pains (only occasionally) my heart rate will only respond to my activity by rising up to 130 where it will not rise any rather. It is as if my max heart rate has temporarily been lowered to 130. It is very strange.
When you had a “negative” test prior, was it because you didn’t have any angina (chest pain) or because they didn’t see any irregular rate / conductions.
Yes. The phenomena I am describing only happens occasionally and I can’t always recreate it. For example it happened to me last Monday but then I was able to successfully do a tempo run the next day on Tuesday and another run on Wednesday. Then it happened again on on Friday, but I was able to do a 16 miler on Saturday with no problem. I had it happen again yesterday (Monday). So sometimes it happens and sometimes it doesn’t which is another odd thing if it was a heart issue. It has also never happened while swimming or biking at any intensity.
I work in Cardiac Rehab, too (10 years)and you should know HRM’s won’t register PVC’s. No one knows how quickly Heart Disease can progress, but I have seen patients arteries clog much quicker than 2 years. Go see your Cardiologist, request a stress test or angiogram. Angio is the only definitive way to guage whether or not blockage is present. PM me if you want more info. R.J.
Thanks for the comment, but PVC doesn’t seem consistent with my symptoms. I guess a blockage could cause these symptoms and I will definitely ask about a angiogram, but if it was a blockage then it why would it limit my the upper limit my heart rate and why only occasionally and why only at intensity and not occasionally at reat. It doesn’t make sense to me.
I had the exact same symptoms recently. Stress test negative for ischemic changes and ectopy. Cardiologist said it was strained intercostal muscles. He recommended I take Ibuprofen to treat the symptoms and it went away immediately. He said that as I get in better shape these intercostal muscles will adapt and I won’t experience these symptoms. He was right. This is my case. Hopefully yours is the same, however, I would speak with a doctor. Hope this helps.
Why wouldn’t a HRM not register a PVC as a beat?
Dave
I’ve had chest pain a few times while running, it’s while running hard. I did mention it to a doc who had me get an echocardiogram, albeit it in a resting, non-stressed state. Everything was fine. I believe in my case quite confidently that it was in fact skeletal muscle stressed from doing flat barbell bench pressing. I hope that’s the case, anyway. If it became a regular thing I would step up attention with a doc, because chest pain is not cool.
It could be a coronary spasm which can cause angina(chest pain) but really does not do damage to the heart muscle. The cardiac muscle spasms just like a normal muscle cramp and the Cardiologists I’ve talked to are unsure of the reason. That could be why you are able to do long workouts with no symptoms. If you are having EKG changes with exercise, its highly likely your hrm is not picking up some of the skipped beats depending on the make and model.
http://www.polarusa.com/...B0BCC225743A003F744E most HRM’s see ectopy or arrythmia as interference and then average the HR after that. Polar site has more detail. R.J.
Low heart rate during exercise can be a sign of low carbohydrate supply (aka “bonking”). If you don’t have carbs for fuel (due to restricted calorie intake, for example), your body switches to more predominantly fat for fuel, which forces lower output. Do you ever feel hungry at that point?
When you say chest pain, do you mean inside your chest cavity (like at your heart)? As opposed to side, ribs, abdomen, etc.?
I have been doing triathlons for over three years now and have been slowly getting my weight down to the point where I am only “over weight” instead of obese. Mid-way through my first season of training two years ago I started to occasionally develop chest pain while running. It would happen when I was trying to run hard and my heart rate would only go up to a certain point. My max HR is 185 but my pulse would only go up to about 130 or so and then no further. I would then start to feel chest pressure like I couldn’t breath and would be forced to slow or stop. The pain would go away immediately, but if I started to run again it would come back at the same HR.
This happened a handful of times and I had an EKG done and a stress test and they both came back negative. I notice from my training logs that the events seemed to be preceded by particularly hard training sessions and relatively restricted calorie consumption in the days leading up to it. So I started keeping close track of my calories and not letting my self get into to much of a deficient and have not had any further incidents of this type for over two years in which I have done numerous triathlons, running races and a marathon. Because I couldn’t get my HMO to cover it and because I stopped having the problem I never saw a cardiologist about it.
Now, tow years later I am training for another marathon and I am experiencing the same phenomena again. I have been a bit more restrictive in the calories to get my weight down, but the other day I even had an event after basically binging all weekend. I have a referral to a cardiologist who I will see in a few days (yea! new insurance), but I want to be armed with as much information as possible, because I expect he will just tell me to stop running. I have scoured the internet for any information on what this could be and have come up with nothing. If anyone has experienced this or heard of anything like this before I would appreciate any info you might have. Thanks!
First, I am not a medical practitioner, so take what I say with a grain of salt.
Second, I see some eery similarities to my story:
In November, 2006, I was staying in a hotel in Columbus, OH, and did not have access to a gym. I was running stairs for exercise. I was on floor 48 and was planning on going 50 when I started getting a tightness and dull pain in the center of my chest. I aborted the workout and went back to my room and lied down. I considered calling 911 and in retrospect I should have. Instead, after the pain/tightness subsided after about 10 minutes I got up but did not work out. For the rest of that day if I did any activity to raise my heart rate over 90, the pain/tightness returned. I flew home the next day and saw my general practitioner. She did an EKG which was negative and suspected exercised-induced asthma and gave me a referral to a pulmonologist and a cardiologist. (I am on a PPO and could have seen these specialists directly and, in retrospect, should have).
I saw the pulmonologist the next day and it was negative.
I saw a cardiologist in a couple of days and they had me start an exercise stress test and told me to tell them when I had chest pain which was within the first minute or two. The cardiologist came into the room and immediately told me they had to do an angiogram to assess blockage and stent it at the same time. I asked if there was anything less invasive and he offered a nuclear stress test and, as fate as would have it, they had a cancellation at that time. I took the nuclear stress test and it confirmed blockage. (What I have learned since then is nuclear stress test can confirm blockage, but not rule it out as there are potential false negatives.) I ended up with a stent on Thanksgiving day, 2006. The blockage was 99% and if it had blocked completely, I would have had a myocardial infarction (heart attack).
As an aside, the cardiologist noticed my dilated aorta in 2008 and I ended up with surgery to replace my aorta and aortic valve last year with a homograft from a cadaver. I did my first HIM on the one-year (and 1 day) anniversary of my surgery.
What I have learned:
- Chest pain is to be taken very seriously, particularly if you are over 35 and more critical with every year after. It could be minor or it could be potentially fatal.
- EKGs cannot spot blockage reliably, if at all.
- Nuclear stress test and some other non-invasive tests might be able to pick up blockage, but the only surefire method is angiogram.
Good luck!
Low heart rate during exercise can be a sign of low carbohydrate supply (aka “bonking”). If you don’t have carbs for fuel (due to restricted calorie intake, for example), your body switches to more predominantly fat for fuel, which forces lower output. Do you ever feel hungry at that point?
When you say chest pain, do you mean inside your chest cavity (like at your heart)? As opposed to side, ribs, abdomen, etc.?
The pain (not sharp - more like someone is squeezing my chest) is inside my chest, right near the sternum to the left. The low carbohydrate idea has been my running theory for a while, but it seems like it would just make me weak and not actually cause pain in my chest. That’s what I don’t understand. My primary doctor thinks it could be some muscle and advised my to take some Alleve around the clock for three days. I have been doing that and haven’t had a repeat of the pain yet. I will see the cardiologist in a few days.
First, I am not a medical practitioner, so take what I say with a grain of salt.
Second, I see some eery similarities to my story:
In November, 2006, I was staying in a hotel in Columbus, OH, and did not have access to a gym. I was running stairs for exercise. I was on floor 48 and was planning on going 50 when I started getting a tightness and dull pain in the center of my chest. I aborted the workout and went back to my room and lied down. I considered calling 911 and in retrospect I should have. Instead, after the pain/tightness subsided after about 10 minutes I got up but did not work out. For the rest of that day if I did any activity to raise my heart rate over 90, the pain/tightness returned. I flew home the next day and saw my general practitioner. She did an EKG which was negative and suspected exercised-induced asthma and gave me a referral to a pulmonologist and a cardiologist. (I am on a PPO and could have seen these specialists directly and, in retrospect, should have).
I saw the pulmonologist the next day and it was negative.
I saw a cardiologist in a couple of days and they had me start an exercise stress test and told me to tell them when I had chest pain which was within the first minute or two. The cardiologist came into the room and immediately told me they had to do an angiogram to assess blockage and stent it at the same time. I asked if there was anything less invasive and he offered a nuclear stress test and, as fate as would have it, they had a cancellation at that time. I took the nuclear stress test and it confirmed blockage. (What I have learned since then is nuclear stress test can confirm blockage, but not rule it out as there are potential false negatives.) I ended up with a stent on Thanksgiving day, 2006. The blockage was 99% and if it had blocked completely, I would have had a myocardial infarction (heart attack).
As an aside, the cardiologist noticed my dilated aorta in 2008 and I ended up with surgery to replace my aorta and aortic valve last year with a homograft from a cadaver. I did my first HIM on the one-year (and 1 day) anniversary of my surgery.
What I have learned:
- Chest pain is to be taken very seriously, particularly if you are over 35 and more critical with every year after. It could be minor or it could be potentially fatal.
- EKGs cannot spot blockage reliably, if at all.
- Nuclear stress test and some other non-invasive tests might be able to pick up blockage, but the only surefire method is angiogram.
Good luck!