Athlete's Heart vs. High Blood pressure

I am a 39 year old, very healthy male living in NYC.

Went to the Cardiologist several days ago due to minor chest pain.  Dr. took EKG - perfectly normal.  Took BP:  127/90 & then, later, 130/90.  4 years ago it was the same.  

He then took Chest X-Ray.  He detected a very mild enlargement, said that it was so mild that perhaps other doctors would have disagreed as to whether  it was "enlarged" at all?.  In any event, he compared this chest X-Ray with the one from my prior visit 4 years ago and said that there was definitely a bit of an enlargement, but, again, what he characterized as mild.

He wasn't certain whether mild enlargement was attributable to my BP (noted above) or whether attributable to fact that I ran the NYC Marathon in 2005 and again this past November (06).  Also, I began working out with a Trainer this past October (2006) and she has me running steps and doing tough sprints. I am panting at the end, she really works me!!!

1.  Any way to distinguish between Athlete's heart and enlargement attributable to high BP?  2) If the latter, can this enlargement be reversed or controlled with BP Meds or diet?; 3) How serious a condition is a "mild" enlargement and how "high" is BP of 130/90?  4) my marathon running and work outs are fine, no fatigue, etc.  Any reason for me to stop because of this mild enlargement?  5) the Internet has so much on Heart Enlargement, it's all scaring me (I have OCD!).  Thanks!!!
              

[anacyde]

1. Any way to distinguish between Athlete's heart and enlargement attributable to high BP?

An echocardiogram should provide a clearer answer.  You definitely need an echo.  Chest x-ray is a lousy way of accurately assessing heart size.

2) If the latter, can this enlargement be reversed or controlled with BP Meds or diet?;

It's very possible IF blood pressure is causing the enlargement and there is a reduction in blood pressure.  

3) How serious a condition is a "mild" enlargement and how "high" is BP of 130/90?

The seriousness of your heart enlargement will depend on the cause. It needs followed.  Normal blood pressure is 120/80 and below.  Yours would be borderline or early stage hypertension.

4) my marathon running and work outs are fine, no fatigue, etc. Any reason for me to stop because of this mild enlargement?

Only your doctor can say for sure.  Usually, people with enlarged hearts are encouraged to stay fit and active in addition to taking medications if necessary and following a heart healthy lifestyle and diet.

5) the Internet has so much on Heart Enlargement, it's all scaring me (I have OCD!). Thanks!!!

Stop reading the internet until you know why your heart is enlarged.  People scare themselves unnecessarily when they only have half a diagnosis.

I hope everything turns out well for you.

[kitcurious]

Is your BP 130/90 when taken outside the medical office? Does your doctor have access to a 24-hr. ambulatory BP monitor? I ask because many people have an elevation in BP when they visit a doctor, especially if they are prone to being anxious. I noted that yours went up while you were there in the office.  It's possible your BP isn't even borderline, but normal. Can't hurt to ask about about a 24-hr. ABPM.

[va_tony]

I don't think there is much cause for concern.  As the doc says, some medical professionals might not even call your heart enlarged. Thirty years ago, a BP of 130/90 would be considered borderline. It's only recently that BP guidelines have been lowered.

Did your doctor say what portion of the heart enlarged? I think high BP tends to enlarge the atria first, whereas athletes typically have a thickened ventricle wall.

You probably should start taking a med to lower your BP if for no other reason than to head off potential problems as you get into your 60's and 70's.

Keep exercising.

Tony

[millaw]

Thanks Tony. Most appreciated. Thanks so much for taking the time.    

[va_tony]

Yes, I think just the training associated with preparing for a marathon tends to enlarge the heart.  Here's something I found on the web about a German study -- it appears (from the runners ages) those studied were average marathoners and not the elite:

"German researchers find.

Their study included 110 males, ages 50 to 72, who had all completed at least five marathons in the previous three years. The men had no symptoms or known history of cardiovascular disease or diabetes.

However, MRI scans showed that the marathon runners had heavier hearts, with an average left ventricular mass (LVM) of 141 grams compared to an average of about 77.5 grams in the general population. LVM is the weight of the muscle of the left ventricle, the heart's main pumping chamber.

"The change in the heart mass is the way the body reacts to the endurance training."

Regards

Tony

[millaw]

Thank you guys so much for your responses. Very helpful.  One last question:  Is it possible for an individual of my age who is not an "elite" athlete but just a marathon runner and someone who works out HARD interval training with a trainer to the point of panting to develop an athlete's heart?    

[trumans]

testing posting....I might have similar problem of the same two variables possibly contributing to LVH

[trumans]

I'm 29. I've been an avid runner since age 14. I probably averaged between 40 to 50 miles a week most of my life between ages 14 to 27.  I've run a 2:56:49 marathon (this put me in the 1st chute of entrants at the 2005 Boston Marathon) , 1:20:44 half marathon, 55:20 15K, and ran track and cross-country back in high school. During this same time period of 14 to 27 I've had systolic blood pressure levels between >120 and <140. Last two years I've cut back and probably average about 25 to 30 miles a week with running with some the miles still occurring at  a decent ~6:30 min/mile pace.

Last August I started experiencing a couple of instances of chest pains not while running, but while at rest. I went to a GP several times in the last couple of months, my blood pressure on the 1st couple of visits was constitent with my past history (I had systolic counts between 128 and 138 and diastolic between 78 and 90). I then as part of an experiment to measure my bp took 100 measurements over a month time period at drug stores and my average came out to 141/87. My last visit to the GP my count was much higher 155/88. Then the other day I visited a cardiologist where my values were elevated even further (164/100 (nurse reading) and 160/80 cardiologist reading).
The cardiologist noticed a soft systolic murmur and has recommended an echocardiagram to test for LVH that I will be in having in the next couple of weeks. (Note: I've already has two separate ECGs that have shown Vent rates of 61 and 63 with slightly elevated PR intervals of 198 and 212. This would lead me to specualte that at a better fitness level a couple of years ago my vent rate must have been mid 50s).

I find that I'm kind of in a similar situation as Millaw where I have two separate variables that might be potentially leading to LVH. If I do have LVH the more recent last couple of months would tend to indicate that it is a blood pressure issue, but futher history could maybe indicate border line athlete heart. Right now on the blood presusre front I'm going on a high potassium low sodium diet the next 3 months as a last attempt to reduce my blood pressure without going on medication. I've dtermined while I ate very healthy I was probably eating too much whole wheat bread (typically I've eaten at least a loaf a day on average for the last 10 to 15 years, this alone can put the daily sodium level above 2,500 mg/day.)

I'm just a little discouraged and frustrated right now that there is not enough literature out there on the web concerning high blood pressure in healthy people or any studies or analysis on LVH that are running multivariate models that take both BP and exercise into condsideration. This exchange was a bit of fresh air in that respect.

With the above background I have provided I was hoping you could maybe help to guide me a little on the below list of questions. I know the Echocardiogram data will help further, but I just wanted to get a little bit a of an overview on this area.

1] What is the typcial ltime duration it would take with someone in the pre-hypertension or hypertension I or II stages to start developing LVH?

2] Can a non-elite, but strong endurance athlete develop  LVH?

3] Is it possbile for the heart to ever return to normal if LVH was caused by 1] blood pressure or 2] running or 3] a combination of both 1] and 2[?

4] If I developed LVH through blood pressure, is running decent amount of mileage per a week at a decent pace still going to be possible. Will my life-style need to become less active?

5] What is the best ambulatory blood pressure cuff? I bought the OMRAN 711 DLX model the other day and started taking home measurements that are showing values lower than doctor and drug store visits (sys between 125 and 135 and diastolic between 65 and 80). Is there a major difference between the OMRAN 711 model, 740 model, and 780 model or is there another brand that is better than the "#1 Doctor recommended brand"?

[Momto3]

Kudos on the excellent training!!

I just thought I'd let you know that you might get more responses from your post if you started a new thread.  Just cut and paste your comments/questions into a NEW post (click on the link to "Post a Question" above).  More people are likley to notice your post if it is not on the back of a relatively old thread.  If you want to address your questions specifically to va_tony, you can put something of that nature in the "subject" line.  However, you might want others to also respond.  There are a few posters here who are avid runners and they may also be able to share experiences, etc.

You can also send a member a private message by clicking on his screen name.  If you're going to do that, it would probably be a good idea for you to build a profile (see link above).  You can be discreet or you can provide some background.  Then you will be able to use the boards more effectively.  Hope that helps.  Sorry I couldn't answer your questions.

[va_tony]

Hi trumans

Thanks for the vote of confidence by asking me such tough questions. I'm afraid I don't have definitive answers for you as I'm not an expert on athlete's heart nor am I an MD. I'm just another heart patient.  I ran a lot in the past (even marathons 30 years ago but was more active in martial arts) and still work out at a gym (treadmill, Nautalus machines and some free weights). My previous vigorous athletic training may even have contributed to my current afib problem but I doubt it.  I think on the whole exercise is good for you and you should do as much as you can. Keep up the good work.

I'll take a stab at answering your questions but it's likely that other board members know more.  Hopefully, they will join in the conversation.

"1] What is the typcial ltime duration it would take with someone in the pre-hypertension or hypertension I or II stages to start developing LVH? "

If the BP is high enough, I understand it can be quite short, weeks even. However, usually it is years.  In your case, I think it highly unlikely at your age that you would develop LVH from your current BP levels, especially to the point of causing chest pains. I suppose there could be genetic causes if there is a family history (??). If you do have LVH, I think it more likely that it's due to athlete's heart OR a combo of high BP plus athlete's heart (the two parameters/variables are likely additive... so it's probably not a question of either or).

It may be that your chest pains have nothing whatsoever to do with the heart... perhaps some muscles aching. I think after the echocardiogram, the cardiologist will be able to rule out a number of concerns.

"2] Can a non-elite, but strong endurance athlete develop  LVH?"

Most MDs will say that only elite athletes develop athlete's heart.  But I reason that if you are training almost as hard as an elite athlete, as you are, and have LVH, then the training must have contributed. Keep in mind, if you have LVH, it might be due to a combo of high BP AND vigorous athletic training..

"3] Is it possbile for the heart to ever return to normal if LVH was caused by 1] blood pressure or 2] running or 3] a combination of both 1] and 2[? "

Yes. Some with cardiomyopathy (and low EF) have mentioned on this board that with proper treatment considerable reversal often occurs. About ten years ago, when I was more active athletically, echos showed that I had some LVH. Lately, the echos show wall thickness in the normal range.

"4] If I developed LVH through blood pressure, is running decent amount of mileage per a week at a decent pace still going to be possible. Will my life-style need to become less active? "

I don't see why you would have to become less active. In any event, your pre-hypertension should be treated. I avoided taking meds for many years (like you).  I now regret that. The meds work and lower BP to normal levels and so avoid unnecessary problems later in life (that I now have).  You may have to ask your doctor to prescribe a med that doesn't affect your athletic performance--- some meds limit maximum heart rate.

"5] What is the best ambulatory blood pressure cuff?"

The model you have IMO is as good as any other IMO.  Consumer Reports ran an article a few years ago and recommended as number 1 the Omron Intellisense HEM-711AC. I've tried a number of the lower priced Omrons and they seem OK (I'm using a manual Omron-432C currently). The home measurements do tend to be lower than the doctor's office... but this can be due to white coat syndrome, being more relaxed at home with perhaps even some bio-feedback thrown in. I did notice the biggest source of error for me personally was getting a larger size cuff.  Because of weight training my biceps are about 16" circumference.  The smaller cuffs seemed to give higher readings

Good luck with your echo.  I suspect that the cardiologist is going to tell you that your heart is normal.

[Momto3]

I'm so glad you saw truman's post!  I wasn't sure if you'd notice it since it was on an old thread.

Hope you are doing well.  How's the afib?  How's retirement?  Hope you're enjoying every minute of it!

Happy Holidays to you and your family!
connie

[va_tony]

Hi Connie

It was easy to see truman's post... I've got my priority settings adjusted to pop the thread with the most recent reply to the top of the list.

Along with my cardiologist and EP, I've decided to opt for the rate control approach to my afib. So I'm now in permanent afib but feel fine.  My rate is well controlled (60-80 range) and I am asymptomatic and able to function like I did in NSR.

Retirement is sweet. Plenty of time to dote on the grandkids. I still consult for a non-profit about half-time which both pays well and keeps me doing something I enjoy.

I'm so glad you finally uploaded a photo to your profile.  Now I can see the pleasant and attractive face behind all the nice messages!

Best wishes this Holiday Season and for a healthy and happy New Year for you and your family.

Tony

[Momto3]

Thanks Tony.   I'm glad to hear you're enjoying retirement with all those grandkids!  Consulting on a half-time basis is especially nice, the best of both worlds : )

[trumans]

Va_Tony, Momto3,

Thanks for your very quick responses. I've gone ahead and started a new thread external to the current one per Momto3's advise.

I'm cerrtainly hoping that I don't have LVH due to a blood pressure issue. It's a little scary to think that this condition can develop in a number of weeks as Tony indicated. Blood pressure as I've read is supposed to be symptomless until later in life. I'm still trying to figure out the root casue of the chest pains I experienced and would think that blood pressure alone would not explain the situation. There is no current family history that I know with LVH and everyone in my immediate family is fine on the blood pressure and heart front. There are some warning signs on my mom's side of the family however. Her father died of a heat attack at age 49 and both my 1st cousins on my mom's side are on BP med.

It's good to hear that LVH is reversible and that Tony was able to return to normal wall thickness levels. I think I can deal with whatever problem I might potentially have in so far as I know there is a methodology and approach for obtaining a solution.

If I do go on BP I will be sure to get ample information and advise on the type that will still permit for a heatlhy active life style. What I've read so far is that ACE inhibitors tend to be best on this front.

thanks for your help and advise and I'll keep you posted on the developments.

best regards,

Truman

[Duceman]

Why would anyone get an opinion from a Doctor and then turn to an internet forum for another opinion is strange.  Kinda reinforces that you worry too much and will listen to anybody that will give their opinion.  Get your second opinion from a Dr.!!!!

[vienna13]

You know, some posters on these boards are just as knowledgeable as any good doctor -and people somehow know that-  va _Tony was one of them! He helped with his great answers for many people here and other internet places.  You can trust in my words! Thank you for bringing that up, now more people can read these useful informations  on the first page!:)