Heart Issues...Raleigh Area Triathletes chime in

Triathlon Forum
1

Hey everyone:
I’ve been a Google and Slowtwitch fiend, trying to find more info and a means to get some closure to an issue that’s been keeping me down. In short - recommend me a cardiologist in this area that has experience with endurance athletes…read on if you want to know why…

After a long, stressful winter that included a move to this area - I resumed my training. During one of my swims in the pool, while resting between sets, I felt my heart go into a 3 beats and a skip pattern…This wasn’t really new to me, as I’d felt it before while living in St. Croix…but thought nothing of it since it went away and didn’t return but once or twice throughout an entire year of training. This time, I noticed that I got a little dizzy and immediately stopped…a day or two later, it happened again - but during a run…then again, but while on the bike. I’ve read all about PVCs and Atrial fibrillation, etc. but I don’t seem to fall into any of these categories.

This arrhythmia is predictable and happens every time I come to rest from an effort, with my heart rate dropping into the low 150s and then into the 140s…if I bring the intensity back up, the HR goes back to normal…if I wait and take a few deep breaths, I can feel it go back to a normal rhythm when it reaches the low 130s. Also, if I overdo it, or stay anaerobic too long chasing one of our many group rides in this area (hehe) I feel like crap the rest of the day/night. (Not normal for me) Feels as if I’m having a constant adrenaline rush…and then have a hard time sleeping.

Furthermore, I started seeing a cardiologist. The only thing that remains is the stress test, which will come Monday. Of all the tests I’ve had done: EKG, Blood work, Echo, Holter, the only abnormality she found was that in my sleep - my heartrate drops to 41bpm (normal for us right) but then skips, regularly. She attributed it to a strong vagal tone. (Vagus Nerve slows heart rate - strong vagal response due to training causes stronger conduction in combination with low resting heart rate in turn causing skipped beats) <— sure, it makes sense. So after being told that if I weren’t an athlete, and young - I’d be a pacemaker candidate, but that what I’m experiencing is not life threatening, I was cleared to continue training, and told not to worry. Comforting, but, I still left with many questions unanswered, such as - *why my heart skips during exercise - why I feel like crap now after tough workouts - why I’m now so aware of my chest all the time - why this seems to have worsened. *

Today, I left with more questions than answers, and that wasn’t my intention. I live in the Raleigh area (Cary), and am strongly debating looking for a second opinion pending the results from my stress test. (Hopefully, I don’t break their treadmill – I’ve heard stories hehe) What I’m looking for though, is a cardiologist who is well versed and experienced with endurance athletes (am I searching for the Holy Grail?) Surely, I can’t be the only one in the world that’s experienced these symptoms…I keep hearing I’m in a great area for what I need…but, where do I go!?

Thanks for reading 'n responding :slight_smile:

2

well this is a bit strange. im in the raleigh area as well and was just commenting to my wife that at night when i am finally resting, i can feel a slight arrhythmia. i have a normal beat, then a rapid follow beat, then a long pause, and then a deep followup beat, then back to normal.

i dont/cant notice it during workouts, but resting i can pick this up just by feel.

my initial thought is HTFU. but heart stuff is probably something you shouldnt mess with/underestimate. will bookmark this thread and let me know when/if you find some solid answers.

3

From all the reading I’ve done - it seems as if palpitations are common in everyone - especially athletes…but I still think it’s rather unnerving…

4

Be sure to take external factors into account…I had problems where every so often my heart would skip every 10th beat, and once it did it it would last a while. Went through the cardio, Holter, stress test, etc., and everything appeared normal. As soon as I cut out caffeine, the problem stopped (and I wasn’t drinking all that much, not even enough that I’d get a headache if I went a day without it).

5

HTFU is stupid with the two c’s; cardiac and cancer.

Unfortunately, in this litigious society, the safe approach for a cardiologist is to recommend that one not do triathlons, but, often there is no medical basis for this recommendation.Yes, get a second opinion. Or a third opinion. I am a cardiac patient myself (stent in 2006 and open heart surgery in 2008 to replace my dilatated aorta. Opinions from various cardiologists range from recommendations to take up brisk walking from here on (he was was not my cardiologist but told me what he tells all his patients) to my current cardiologist’s opinion that I am in no more danger and actually in less danger than the general triathlete public. He had no objections to me doing my first half iron last Sunday.

By the way, I am a former Crucian, having lived on St. Croix from 98 to 99. I plan on doing the beast next year.

6

Ramasan,
It sounds like what you are experiencing is pretty common in endurance athletes. Your heart rate changes with your respirations, which if I understand correctly is a normal variant. I believe it is called “athletes heart” or something. Mine does the same thing but the only time I usually notice it is when I am laying in bed and all is quiet. However, if you have symptoms with it definitely get it checked out.

7

To the OP,
Try to simulate during your stress test what happens during training to repeat this arrhythmia. It will give the Dr. a lot more info as to what is happening with you. I know that is easier said than done, but you said that it is after intense efforts while your heart is slowing down. Make sure the administer of the test is aware of this and pushes you a little harder.
I work in a cardiac center doing echocardiograms and stress tests so the more info they can get during the test the better. Smart move getting the tests done in case it is a serious arrhythmia you are going into.

Good luck and let us know how it goes.

Mike

8

Welcome to my life. I’m afraid i can’t offer any help with cardiologists, but what you’re describing seems very similar to what I’ve been experienceing for the last 4+ years. skipped beats, irregular pauses, slow heart rate, extreme fatigue, and above all having nothing definitive show up on all the tests the cardiologists do. Holter monitors, event monitors, stress tests, echocardiograms…

I have been diagnosed with atrial fibrillation, based on the EKG from an emergency room visit several years ago when my hear was jumping all over the place. I still have what I think are regular A-fib episodes, but 90% of what bothers me are these wierd missed beats, weak feeling, etc. that the doctors haven’t identified as anything abnormal (based on event monitoring and holter tests).

At this point my competative days are long over, I’m happy when I can exercise enough to feel healthy. the heart seems to get worse both when I exercise too much (duration, and especially intensity) and when I exercise too little. The balance is hard to find - especially since other factors that seem to affect things include stress at work, sleep, fatigue, diet, how recently I’ve shaved my head, and the phase of the moon.

As much as you don’t want to hear it, my advice would be to ease off on the competative training until you figure things out. I spent the last 2 years of my ‘serious’ ironman training going through these 2-3 week cycles where I’d have 1-2 weeks of good training, and then a few days where I’d finish hard workouts and just feel like i was in a fog - falling asleep on the couch after long rides and feeling delierious and unable to wake up afterwards- just lying there in a haze feeling like I couldn’t even lift my arms up, etc. then I’d take several days to a week off, and then go through the cycle again. I have to wonder if I’d be in as bad off as I am now if I had taken it easier when my body was telling me to take a break.

that being said, i do have another cardiologist appt next week. I’m hoping that medical technology keeps improving to the point where we can figure out what’s wrong and do something surgically to correct it. I happen to work for Medtronic, and know that we are putting a lot of money and effort into A-fib treatments. maybe something good will come out of it.

Good luck!
J

9

Ramasan,
It sounds like what you are experiencing is pretty common in endurance athletes. Your heart rate changes with your respirations, which if I understand correctly is a normal variant. I believe it is called “athletes heart” or something. Mine does the same thing but the only time I usually notice it is when I am laying in bed and all is quiet. However, if you have symptoms with it definitely get it checked out.

that pretty much sounds exactly like what i experience.

“athletes heart”. i think i can live with that :slight_smile:

10

I think a cardiologist would be in order, although I would think that you may want an electrophysiologist to have a look as well. Sure cards are wonderful, although when it comes to heart rhythms, get me to an EP (I currently work with both). Everyone has skipped beats at one time or the other. When I had mine a few weeks ago, I never had felt them in my life. They lasted for about a week. Mine were PAC’s, which when they happened, I lost my atrial kick, which means I felt like shit, dizzy and lightheaded. I don’t do caffeine so that wasn’t the issue. There are many things that can cause skipped beats, for example high potassium, low potassium, electrical disturbances in the heart, etc. My docs said to not worry about it, although they did say I should have my thyroid checked. As it turns out, I’ve got subclinical hypothyroidism and the endocrinologist is going to treat it with some minor thyroxine. Many times in the setting of these things, the thyroid is overlooked. My bet is that you ace the stress test and it turns out just fine, as they will be looking @ muscle wall thickness and ejection fraction. While this sucks, anxiety and stress are other animals to consider when dealing with ectopy, or skipped beats, so stop checking your heart rates (easier said than done, I know). Good luck and hang in there.

11

Besides external factors like caffeine, low sodium and magnesium, stress, I found that the anxiety I felt when this was happening to be was the worst contributor. I would get to the hospital, and my anxiety would go away, and so would the symptoms. Try and relax if you can, and notice if it gets worse when you worry about it. At least that is something you can control, either by just recognizing it, and talking yourself down, or using meds that control it. ANd you do need the docs to be able to see what is exactly going on, otherwise they just say it is normal for athletes. And in your case it very well could be, probably is, but maybe not. I finally went home with a 24 hour halter monitor, and once they read it, they knew I had big problems. But all the tests in the hospital, twice, did not show one bad thing…

12

Thanks for the advice - I’m looking for an electrophysiologist in the area…I found one at UNC…but would really like a referral to one from a fellow endurance athlete. You know how it is. The cardiologist I’m with now really has no experience with athletes. Red flag for me - but I’ve decided to give her a chance.

I rode my bike today…and afterwards, while training a client at work, I felt exactly what you were describing; Almost like a constant adrenaline rush, light headedness, being aloof, and a feeling of shit. lol I’ve had bloodwork done and my electorlytes and thyroid all checked out…In addition to that, I just started supplementing with potassium, calcium, and vitamin E. Haven’t noticed any changes despite it…so maybe I’ll stop with them.

The problem with all of this is - it’s gotten worse since last season. I had 3 episodes last season…that was an entire 10months…3 episodes. Now I feel it EVERY workout! crazy…

Thanks again everyone, for weighing in - I appreciate your thoughts and comments.

13

sorry I’m not in the area, out west by the way, but I think that if you talk to any electrophysiologist and make them listen to your work out habits and the like, that they’ll be more inclined to not take an everyday approach to what your saying. athletes are a dime a dozen, until you tell a physician the structure and timing of how much you do exercise within a week’s time. One of the EP’s I work with ran a 3:58 mile in harvard and is one of the top cyclists in the state, although he would never tell you that he is geared towards athletes. However, he would be more investigative in your symptoms if you tell him what your exercise regime looks like. like others have posted, could be something, although it may be nothing, best to let he/she decide. I have a very prolonged atrial depolarization as many endurance athletes have, unfortunately I work at a heart institute and go through the hassle of giving myself ECG’s every so often just to make sure I can still get anxious over it. I do get an echo before and after ironman events just because I’m curious to see how much acute heart failure I can give myself, I’m 37 by the way. Hang in there and stay positive.

14

Hi,

I don’t live in the area anymore, but there is a practice in Cary off of Cary Parkway (toward Inside Out) that specializes in Sports Medicine. I should know the doctors names but I dumped that information i guess. There are a number of them in this practice with different specialties and most of them are either athletes or have worked with them. Cary Sports Medicine and Family Practice or something like that.

Good luck to you!

15

Hey Monty, how’s it going? May I ask what your symptons were and the treatment you were given that resulted in you ending up with a pacemaker.Reason I ask these questions is that I have joined the AF club and need to present myself when having an episode to have an echocardiogram to see if they can find out whats happening.
Guess I will be getting on the medical merry go round pretty soon.
Hope you are well and training hard for your races this season

16

Hey Paul, nice to hear from you, and yes, a lot of us will be in that club before we retire from sport(otherwise known as dead)… I did not have AF, but that is the most common among people it appears. I had a complete electrical block between the atrium and ventricle, so I had the opposite. My heart would just stop beating, while most of you go to 300 and get stuck. Dan also expirenced what you have, but he has managed it by taking magnesium, sodium, and trying to limit his stress. So far so good, but he knows too he is just a step away from mechanical help someday.

As I said in my earlier post, if you are having symptoms regulary, but not when the doc is around, then get them to put a halter monitor on you for a day or two. It will record every beat during that time, and they can download it and get a better picture of what is going on, and how often. But make sure you get your electrolytes checked, especially sodium and magnesium. It was a very low magnesium for me that set me off finally that sent me to the emergency room. Those two can really screw up your heart and its rythm when they are off, and you are training or raicng hard…

Good luck Paul, and let me know how it goes,
Monty

17

Dtrain

I am not sure if they are or actually participate in endurance sports but Dr. Chow and Dr. Wesley of Wake Heart and Vascular Associates (based at the Raleigh campus of Wakemed) have done some presentations with regards to sports so you might give their office a call to find out. There are actually about 23 cardiologists at that practice. This info was given to me by 2 PA’s in the cath lab at Wakemed. Those 2 doctors were the ones that jumped out to the PA’s when I asked if they knew any cardiologists with endurance sport experience.
Hopefully this can lead you somewhere.

18

Hey thanks! I will follow up on your lead this coming week.

I truly appreciate it!
D

19

So the latest: After the winning the fight with the treadmill in the stress test, I was told that I’m tripping my body’s internal defense mechanism against a rapid heart rate…The palpitation is nothing to worry about. Then told to keep it below 188, because everytime I go over, I flip the switch…so to say. Race pace is usually in the 170s for me, but if I have to put in more effort, I’ll easily hit the 180s or 90s. Funny thing is…I feel good at 188…even 192. She says that anytime I bring my HR over 100% this will happen, and I’ll feel the way I do. It’s apparently not atrial either…that general feeling of crud afterwards has yet to be explained - so I’m getting an event monitor (again)

Anyway…I’m cleared…see you guys on the road…