Bradycardia and exercise-induced Tachycardia

[JDM89]

I'm a 35yo male, exercise regularly, have a BMI of 24, and in good health. Running a comfortable pace of a 10 minute mile on flat ground, my heart rate will rapidly climb to about 185-195 and level off. When I sprint or run uphill, I see a sustained HR of 200-210. I've seen isolated spikes as high as 240, during both sprinting and normal jogging. After running, my HR drops quickly to around 150, levels off, and then drops again to about 120 and again levels off .  This is a typical HR profile since I started tracking it about 5 years ago.  The only symptom during running is a tingling when sprinting/running uphill.

I have a normal HR of 60-65, just sitting around. Sleeping, my HR is  relatively flat between 45-55  for about 45 minutes followed by a period of instability of about 30 minutes. During this period my HR fluctuates greatly, spiking up to 90 for a few seconds and dropping to as low as 30-35 for about 1/2 minute at a time.

The only symptoms are occasional sense of "double beats" for 3-5 seconds (once a month), sharp chest pain for 3-5 seconds (once every 2-3 months), and sense of high pressure with loud sound of rushing blood in my ears (once every 2-3 months). None of these happen during exercise. No history of heart problems in my family.

The high HR during exercise seems to indicate poor heart health, but the low resting/sleeping HR seems to indicate a healthy heart. Should I be concerned by the very high HR while exercising?  Any chance of heart failure at such high sustained heart rates?  Should I be concerned about the dips at night into the 30s?

[CCF-M.D.-MJM]

Hi JDM,

The high HR during exercise seems to indicate poor heart health, but the low resting/sleeping HR seems to indicate a healthy heart. Should I be concerned by the very high HR while exercising?

A high heart rate during exercise does not mean poor health -- it is true that in the right person it can mean that, but probably in your cases.  Elevation in heart rate is dependent on your effort, your level of fitness and also some intrinsic variability that we all have.  There is a form of inappropriate sinus tachycardia where heart rates increase disproportionately to effort, but there is no evidence that they are in worse condition.  If you are concerned your heart rate is inappropriately high for the level of effort, talk to your doctor about a stress test and objectively measure it.


Any chance of heart failure at such high sustained heart rates?

Not from heart rates elevated during exercise.

Should I be concerned about the dips at night into the 30s?

Only if they causes symptoms.  If I saw heart rates in the 30's in a resting 35 year old asymptomatic male, I would tell you that you are fine and to come back if you ever have symptoms. I would not worry about resting asymptomatic bradycardia.

I hope this answers your questions.  Good luck and thanks for posting.

[Angie O Plasty]

That sounds somewhat like me, although as far as I know my HR has never hit 240!  I am 22yo, female and run three miles a day (roughly 11 min/mile--not a speed demon at all!), and my heart rate tends to be in the 180's-190's during most of the run, once it gets up there after the first few minutes, and can reach or exceed 200 on uphills or sprints--my max seems to be 211 but I have seen higher numbers that I'm not sure were real (might have been some interference with the monitor).  When I stop my HR drops by 50-60 bpm in the first minute, which from what I understand is a sign of good conditioning, and then goes down more slowly after that.  My resting rate is generally in the 50's or low 60's (depends on how relaxed or not I am) and not sure what it gets down to at night.  I haven't been too concerned, as the high exercise heart rates just seem to be normal for me although I'm surprised they haven't decreased as I get in better shape.  It will be interesting to see what the dr. has to say to you.

[Bromley]

Hi. How do you actually feel when your heart rate climbs to 240?  I realize you must be running hard at this point, but do you feel dizzy or light headed?  When you say "tingling", what do you mean. Tingling where?  Also, do you notice any "instability" while you are lying down when you are not asleep? And how do you know your heart rate is 240? Do you take your pulse, or have a heart monitor? If a heart monitor, do you keep it away from electric fields?

I also wondered whether when your heart rate increases to 240, if it stays there for a while, and then suddenly slows down to a more normal pace? If you stop running when it is a 240, does it continue to run at 240, or does it slow down? Do you feel any sensations in your neck or chest when it is 240?

Last, how often do you run and are you heavy?  10min/mi on flat is a  comfortable pace for a 24 year old.  Do you have symptoms of over training (i.e. feeling blue, difficulty sleeping, etc), or would you consider yourself out of shape?

Good luck.  I hope the doctor can provide some answers for you.

[discobeat]

Found the same thing when I used my "cardio-sport" brand monitor.  seeing 240 at the end of a 5k  is a shock, but the company said it had more to do with an irregular heartbeat and the way it did its math in the computer.  When I ran with a holter on, it never got above 210.  I too found on the holter that I was into the 20's at night.  My doctors defined normal as, hey , if you don't pass out, then it's normal for you.  I did find that with different brands of monitor, the readings were a little more in the norm, or matching what the holter showed.

[jeff 67]

I used to run full marathons (26 miles in sub 3 hours) and my training regime included 6 miles on weekdays and 20 miles on the weekends (always at a fast pace).  My resting heart rate at the time was in the 40's and 30's while asleep.  However, my heart rate during my runs was up around 200.  My heart has always seemed to beat faster than the norm suring exercise and even with the intense training regime I had it did bring it down significantly during exercise.  In stress tests I have done I tend to reach around 110% of my age predicted maximum which just confirms my comments about being above the norm. I have no idea why my heart beats faster than normal during exercise.  My heart is of normal size and I have a normal EF, so from what I understand and have been told, having a broad heart rate range is indicative of a healthy heart and what is most important is how quickly your heart rate recovers after exercise.  The highest heart rate I ever recall reaching was about 220.

[Angie O Plasty]

Well, Jeff, there goes my theory about the high heart rates being any part of the explanation for why I'm such a SLOW runner!  I joke that the only thing that's fast about me is my heart rate--my running pace is 11 min/mile on a good day and if I try to go faster, well, it just doesn't work so well especially if there are any hills involved!  What I'm gathering from this conversation is that the "220 - age = max HR" formula isn't too reliable.  I wonder if there are as many people for whom the age-predicted max is much higher than they can reach (in other words, the opposite of the group that's posting on this topic!)

[cristabelle]

Good questions today.  I learned alot.

[JDM89]

Thanks for all the posts.  Most people I tell about my heart rate think I should be dead.  I'm heartened (sorry, couldn't resist) by the fact there are some other people out there with similar profiles during exercise.  I'm in the Air Force and up until a few years ago they had a yearly test on a bike with a heart monitor.  I pretty much failed every time.  My HR would spin up and they'd stop the test because it was too high.  They had some upper safety limit based on the Age-based Theoretical Max and had no ability to alter it based on observed MaxHR.  If I did manage to get through a test, I'd score in the bottom 5%.  The general idea I was given by the people running the test was it measured VO2Max and if your heart was healthy, then it shouldn't need to beat very much to bring the oxygen to your muscles.  Under that theory, my high HR indicated my cardiovascular system was inefficient at conveying O2 to my body.

I bought a HR monitor and after consistently seeing numbers above 200, I pretty much stopped running for about 2 years, because they made it seem I was in really bad shape and was hurting my heart by running.  They told me to exercise in the 130-140 range and as my heart got healthier I would have to keep increasing the exertion level to get to the same HR.  Walking gets me about 110, but even a slow run get me to 175, so I used an eliptical machine, followed their advice and saw absolutely no change.  Ever.

Started running again last year when they changed the test to a 1.5 mi run and suddenly I'm up near an Excellent score.  A 10min mile is pleasant, and I can step it up to a 8min mile for test time without any discomfort.  When I'm sprinting the tingling I described actually feels more like hyper-oxygenation, but that doesn't make any sense given the activity level, although I'm also breathing very fast.

Again thanks for the posts.  From what I read on this post, high HR during exercise CAN be an indicator of poor health, but is not in and of itself an indicator absent other symptoms.  The "standard" HR conventions don't apply well to the outliers.

[jeff 67]

Regarding the stress test, once you reach your maximum predicted heart rate they seem to be happy to stop you at that point.  In my case, I just kept going each time once I reached my maximum predicted rate.  I don't think my heart rate has ever been higher than on a stress test, and as I said in my previous post I ran marathons and had a tough training regime.

[axg9504]

Anyone out there with exercise induced BRADYCARDIA. I have this problem after exercise stops with symptoms (SOB). My bpm goes down to 50 sometimes 40. Most of the time it last a couple of hours and then I recover to my normal 80 bpm.

[Angie O Plasty]

That shouldn't happen...have you gotten it checked out?  Exercise should make the heart rate increase.  What type of exercise do you generally do where this bradycardia/SOB occurs?

[axg9504]

Yes I've been going to the docs for 4 yrs now and have had caths and EP studies etc . It's a malfunctioning conduction system they say, put in a PM. My bradycardia (which I define as 50 and below) is AFTER my exercise has stopped and I'm resting. 'Exercise' is generally running/walking followed by weights or it could sometimes be as light as pushing a mower. What the docs can't explain to me is why exercise causes it and why I stay in brady mode after..

[Angie O Plasty]

It is certainly weird.  I wonder if it could be something going on with the autonomic nervous system rather than the heart's conduction system malfunctioning--could it be that the parasympathetic system is "overreacting" after exercise and that's what's causing the bradycardia?  I'm no doctor, so you should talk to yours, but that's something I thought of.  Does your heart rate respond normally to exercise?  When your doctors have said you had a malfunctioning conduction system, did they say what they thought the problem specifically was (sick sinus syndrome, AV block etc.)?

[axg9504]

My heart responds initially. If I start running at 9 mt pace, it will go up to 130-140. I'm not fit as I used to be so I can't do more than 5 mts of this. Subsequently if I try to run I'll get dizzy. I suspect my bpm does not respond adequately then. Usually it's around 90 but I can't tell if it will go back to 130 because I can't run long enough cuz of the dizzyness. So I have to just do a fast walk (my bpm stays at 90). Then after I stop begins the brady. I've had conflicting advice from docs in the past but current reco. is to install a PM since meds don't work and then if I still need meds to control whatever upper chamber arryth. I may have, I can take them without fear of prolonging brady. I haven't heard of anyone else who has these problems only on exercise and then be symptomatic after!!! Yes, it seems weird to me too.

[axg9504]

I had an EP study that showed no block. they ablated for an atrial flutter that showed up during the pacing.

[Angie O Plasty]

Do you have a heart rate monitor that you can wear while exercising?  It might help you see exactly what happens with your heart rate when you run.  Also, you could try running at a slower pace and see if you can go longer or if you have similar issues--9 minutes per mile might just be too fast for you as it is for me (even though I'm in decent shape) and running slower might allow you to keep it up longer.

[axg9504]

BTW I like that handle of yours. Regular Irish name(haha). Anyway, I don't want to hog this thread, but to respond: yes I have had a Timex monitor for a couple of years now. I was the one who initiated this investigation of bpm. My first EP would not listen to me when I told him about my suspected brady. My first treadmill 4 yrs ago did not show anything since they didn't let me go long enough. I said 9 mts it's more like 9:40 pace (I could go 7:20-7:40 for an hour 20 yrs ago). It's variable, some days even a fast walk will bring on the problems in 2 mts. Thanks for your concern. If I could be sure that a PM will fix all my problems I would go for it. But I don't trust the docs on this, so I'll wait till I have problems when resting.

[Angie O Plasty]

Well, it sounds like nobody knows quite what's causing your problem.  Your doctors didn't say what specific conduction problem they thought you had?  (I know you said it definitely wasn't an AV block).  It's strange that your heart rate seems to be responding initially and then dropping (I'm assuming that you've manually counted your pulse when the monitor is showing the low rates, to make sure those are accurate readings).  Maybe you need to talk to your doctor a little more and find out if they think getting the pacemaker would take care of your symptoms--you'd think it would, but I'm not quite sure how the programming would work for the rate response in your situation.  However, it's possible that once you went ahead and did it you'd feel a lot better.  Talk to your doctors though, as they're the ones who know your history and what the effects would be.

[axg]

EP says conduction is fine(had EP study). Yes I do have secondary confirm. on low rates. In fact I had a Holter on me for a day after I was in brady for over 12 hours. They saw a lot of pauses too (while I was in brady-it cleared up an hour after they put Holter). It would be nice to be able to run again and I may go in for a PM later. I would want some assurance from monitoring or otherwise that it will help me. I don't want to be on meds as well as have a PM. Right now I take no meds and I can get in enough exercise for health if not for fitness. The only problem is what happens after exercise. It varies very much. Sometimes I recover from brady very quickly sometimes it can take a couple of hours, on rare occasions 12 hours or more..

[Angie O Plasty]

So it's not a conduction issue.  Did they say anything about it being something wrong with the SA node itself, or an imbalance in the autonomic nervous system?

[axg]

My interventional cardio. has been saying for 3 years, after I presented the evidence of much lower rates at the end of exercise that I had chronotropic incompetence(CI) and recently that I may have sick sinus syndrome. My EP only recently has concluded that I could be helped with a PM. He doesn't seem to think much of the idea of CI. I'm not sure that is an established syndrome. Neither has said anything about the nervous system and its effects. I think that may be outside caridology. No one has presented me with a model that can explain all of this. Maybe there isn't, as you know many of these arrythmias are not well explained. Perhaps they think it doesn't matter, just treat the symptoms..

[Angie O Plasty]

Chronotropic incompetence, from what I understand, just means that the heart rate doesn't respond appropriately to exercise.  However, I thought that usually that manifested itself as the heart rate not rising with exercise rather than, as in your case, rising and then dropping.  So it's not so much a syndrome as a particular response (or lack thereof) of the heart to exercise.  Maybe your situation really is just one of those things nobody has a good explanation for.

[axg]

You seem to be well read in this field... My docs say that it's only a matter of time before I will have permanent bradycardia problems. It is so variable. The last two days of exercise have been just great with no problems after! I read your initial post. Do you feel your heart racing with that high a beat? When I first started I couldn't run 1/4 mile, I hyperventilated and came close to throwing up everytime. (I don't remember getting dizzy) The magic marker was a 3 mile run about 4 months after I started running. After that I improved so quickly that I ran a 1/2 marathon in 1:48, less than a year after I started. So if you push yourself and want to you can improve.