Athlete's Heart and Syncope

[tpeterson]

I am hoping that you can shed some light on what my cardiologist is telling me.

I am a male 37 5'10" 175 lbs. I have run many fairly fast marathons and would lift weights 3-times a week. I still have a resting heart rate of 44-50 bpm. A few years ago due to an abnormal EKG (diffuse T Wave)reommended by my PCP afterI passed out at the end of a strenuous workout, I went through an entire workup with my cardiologist (Echocardiogram and thalium stress test). The diagnosis was athletes heart but I was allowed to continue my exercise, with the stipulation that if I passed out again, I had to go back in. It happened a few more times (not while running, usually at night feels like the flu) and I went back for a tilt table. passed out after 4 minutes with drastic drops in blood pressure and heart rate, the echocardiogram shows enlarged left atrium and ventricle (60% bigger), I also have a left side heart murmur.

The doctor's instructions were to eliminate caffeine and sweets from my diet (I don't drink or smoke), to cut my exercise to daily walks of 4 miles and absolutely no weight lifting, to increase my salt intake and to drink a lot more water. After 6 weeks of this I had another echocardiogram and my heart had shrunk somewhat (30% bigger than normal). Now I get 4-mile jogs 4 times a week.

Upon asking, I do not have hypertrophic cardiomyopathy. So can you fill me in on what the relationship is between exercize and syncope and my diet. I'd like to run marathons again is that possible? I've been told a pacemaker will fix it why is that?

Thanks for any insight

[CCF-M.D.-CRC]

Dear t,
Syncope (fainting) is commonly found in athletes.  This is due to a variety of factors.  One reason is due to an increased vagal (parasympathetic) tone in well conditioned individuals.  Another is due to volume shifts with changes in posture and still another is due to the slower heart rates.  The reason for increasing salt is to increase the total body fluid volume.  This helps reduce drastic volume shifts with changes in posture. Other lifestyle changes include elevating the head of the bed 6 inches and wearing support hose.  Exercise in itself is probably not contraindicated in athletes once it has been determined that this is the cause of the hypertrophy.  This is more of a diagnostic procedure to differentiate athlete's heart from hypertrophic cardiomyopathy.   A pacemaker may help but this would only be a last resort.

[Twelve]

I was diagnosed with vasovagal syncope several months ago.  I also have an irregular heartbeat, (ventricular with a short PR).  During my testing and diagnosis, I too was advised to increase salt and water intake only I was told not to exercise at all period.  Obviously with the scare of knowing that something is wrong with your heart really stressed me out to say the least and having to give up all exercise, (walking the dog and riding my horse), it made the stress levels even higher.  Upon my diagnosis of VS, a pacemaker was recommended to me and pretty much forced upon me by several cardiologists and my family doctor.  As I am only 34 years old and in fairly good shape, I felt that the pacemaker was a real jump from simple salt and water so I decided to do some research of my own before I made the decision.  In the research that I have done, there is no study that can guarantee you that with a pacemaker you will not pass out and in some circumstances the person passes out only with a better heart rate.  When I have these episodes, I have at least a sixty second warning period, (sometimes it's a state and lasts much longer),I can avoid the faint by sitting down but it's the horrible sickly feeling that is hard to cope with and no pacemaker can keep your blood pressure at a level that you won't go through the lite headed, fluy feeling.  I have decided to treat my condition with diet and proper but not excessive exercise, I may need a pacemaker someday but the type they install for fainting only comes into play when the heart rate drops drastically and because I know when this is going to happen, I can relax, eat or drink something that will help my body to fight it naturally.
Twelve

[tpeterson]

Twelve,

Thanks for your comments. I've found my experience to be exactly the same with Syncope. Do you have any hypertrophy? I'm trying to figure out the relationship between my enlarged heart and the syncope. My doctor seems to think they are closely related and that the limiting of exercise will shrink my heart and reduce the likelihood of syncope. does anyone else out there have any experience that will help me understand this?

Thanks