Excessive perspiration during exercise

[runnertom]

I am a 58 yo male post CABG 3 1/2 years. I have been a very heavy exerciser for the last 35 doing mostly running and biking. Sometime in the summer after my Feb. surgery, I became aware of a tendency for my head and face to sweat while doing only moderate levels of exercise. I initially attributed it to one of my meds, Altace and Lipitor, but I have been on and off of these over the last three years and the tendency persists. This sweating occurs even in quite cold weather while running when sweating at all seems inappropriate.
   I am concerned about the heart connection since excessive sweating is often a sign of an MI. Stress tests 3 mo and 2 year post CABG show a small mostly irreversible perfusion defect in the antero apical area. Cardiologist is not worried since its so small. Could this be the cause of my sweating? Echos have been essentially normal. I would say that the sweating has not progressed markedly over the last three years, although it is no less annoying.
  I have also recently been diagnosed with exercise induced Afib which 25 mg of Toprol XL seems to be controlling. The Afib was not seriously impacting my exercise performance except I often had an erratic heartbeat afterwards. Sometimes the erratic HB would persist and an EKG confirmed fib. I am thinking I could be in and out of it often during exercise without knowing it. A friend that has Afib said that sweating about his head and face was his most noticable symptom. Could this have anything to do with my problem? The Toprol has not impacted the sweating.

[CCF-M.D.-MJM]

Hi Tom,

Could this be the cause of my sweating?

If you aren't having symptoms of chest pain or shortness of breath it is very unlikely to be of cardiac origin.  If you are very worried about it, a stress test with imaging would answer the question.  From what you have written above, I do not think your sweating is from ischemia.


Could this have anything to do with my problem? (AF)
You could be having AF during exercise.  The easiest solution is to where a monitor when you are working out and check the time of sweating to see if it consistently correlates with the AF.

I hope this helps.  thanks for posting.

[Gaspipe]

I think for many people more seems better in many instances in life. Maybe in your case and those like you more may not always be better.I mean in the sense of overly zealous excercising...maybe doing it at a more moderate level would be a more heart healthly comprimise. Remember Jim Fixx the orginal runner... he dropped dead while running!!  So continue to take care of yourself and don't overdo it. I remain yours truly Gaspipe

[runnertom]

Gaspipe,
Thanks for you comments. I may have left the impression that I sweat heavily during intense exercise. This is not true. Running at any pace that you could call running and riding a bike at maybe 60% of max results in the heavy sweating. I have queried the cardio on numerous occasions whether I need to back off but he is in favor of me doing what I feel like.
Tom

[ventiboy]

You make a good point, regarding moderation, however, Jim Fixx (hardly the original runner) died at age 57. His father (not a runner) died, of a heart attack, at age 43. It's also been stated that Jim Fixx, apparently ignored some symptoms or he might have had an even longer life!

Best,
ventiboy

[Gaspipe]

Hi I meant he was of the first advocates who wrote a book on the subject and advocated running for health purposes. I believe he also had bypass surgery.  Gaspipe

[Gaspipe]

Hi I meant he was of the first advocates who wrote a book on the subject and advocated running for health purposes. I believe he also had bypass surgery.Gaspipe

[axg]

Jim Fixx, was very overweight when he started running, so he may have already sown the seeds of cardiac failure . I think he continued to eat a high fat diet. In those days there was a belief that if you could run a marathon then you'd live for ever. About sweating, assuming that the heart is fine, I believe core temperature is what is important not how much you sweat. If you don't sweat enough and your body is not cooling so that core temperature is higher than it should be then that's not good either.

[runnertom]

Regarding Jim Fixx, I do not remember that he was as old as 57. I thought he was more like early 40's. I don't think he had bypass although I agree he was quite overweight when he started running.
   The theory that running a marathon made you virtually immune to dying of a heart attack was I believe presented by Dr. George Sheehan, another noted author on running. His idea was that the collaterals one develops through long term endurance exercise would protect you from death if you were to have an MI. In my case, it may have been true. I had an extensive network of collaterals such that my running performance was as good as ever even with a 97% blockage of the LAD. I never had any pain and the only reason it was discovered was the investigation of my complaint of shortness of breath in the first few blocks of running. I would never have had a clue that I had a problem if my exercise was confined to bike riding. I guess my first few miles were at a lower level giving the collaterals more time to dilate. The jury is out as to whether I actually needed CABG or not.
  Gaspipe, since my surgery I have queried maybe 8 cardiologists as to whether I should give up running/riding/racing. The opinion has been unanimous that I should keep it up although a few cautioned that I might want to be careful in racing. One often finds in a race that you take yourself beyond the prudent and the intensity could cause plaque assumed to be present to rupture and cause an MI. I think this same arguement could be used for any male over age 50.

[ventiboy]

Yes, I remember when it was widely thought that if you ran 26 miles/week you'd never have a heart attack. Dr. Sheehan may have promoted that idea but I was thinking that it was coming from Dr. Ralph Paffenbarger.

Just a little information on the late Jim Fixx:

When Fixx took up running at 35, he weighed 214 pounds and smoked two packs a day. Ten years later, when the Complete Book of Running (which spent 11 weeks at No. 1 on the best-seller list) was published, he was 60 pounds lighter and smoke-free. The book's strong, clear prose was an inspiration to millions. In his books and on television talk shows, he extolled how physical exercise had considerably increased the average human being's life expectancy.

Fixx died at the age of 52 of a massive heart attack, after his daily run, on Route 15 in Hardwick, Vermont. The autopsy revealed that cholesterol had blocked one coronary artery 95%, a second 85%, and a third 50%. Many who opposed his beliefs said this was proof running was harmful. However, it should be pointed out that Fixx came from a family where the men had poor health histories. His father suffered a heart attack at the age of 35 and died of one at 42. Given Fixx's unhealthy lifestyle until he took up running, many argued that running added many years to his life.

[axg]

I'll throw in another opinion. It may have been Dr. Ken Cooper the fitness guru who opined that marathoning=longevity. At least I'm sure he once thought that intense exercise was better than moderate for cardio health. I believe he has changed since then. RunnerTom: your case history is interesting to me. I used to run , started during the running boom, the Fixx era and then tapered off to nothing over the next 10 years. Anyway I started having exercise induced problems 4 years ago. My problem was initially diagnosed as afib too, but I believe that diag. was wrong. Now I have a slow heartbeat that develops after I stop and can continue for a few hours with symptoms. I'm trying to find an explanation of how exercise can cause this? DO you know of anything I can read about this?

[runnertom]

Axg,
  Why do you doubt your Afib diagnosis? Besides myself, I know three other runners who have/had it and two other non-runners. Their symptoms were all different. Mine caused a moderately elevated erratic pulse (110 bpm) and mildly reduced exercise capacity. I noticed shortness of breath walking steps. My brother (also a runner 6 years younger) had a strong ventricular response where his HR would approach 230 bpm which made it pretty much impossible to continue. Another runner's was similar. Two non-runners has erratic high pulse but were in fib continuously and found it difficult to do daily duties. All have been confirmed by EKG.
   My totally layman's guess for your problem is that none of the atrial pulses are getting through the AV node, causing the ventricles to fall back on their base rate (don't know the actual term, but its what you get with branch bundle block). What happens in Afib is that the disorganized electrical activity is strong enough to cause the atria to contact (quiver) but may not be strong enough to get down through the AV node. To read about it, I would do some searching in the area of bundle block, Afib, AV node, etc in some heart related journals. I would start at:  http://www.ahajournals.org/search.dtl  You can get all the abstracts for free and many of the full articles. If you find one of great interest, they can be purchased for a fee.

[axg]

First, I have a regular interventional cardio that I first started with 4 years ago when I started getting dizzy spells on the treadmill. Then it was after 10-20 mts of moderate pace. Anyway their standard stress tests didn't show anything and a heart cath showed no blockages. A year later I went to an EP who saw 'sporadic afib' in 2 of 4 event monitor sessions. He put me on Toprol (disaster as have all meds since). I didn't like this EP and am glad I avoided the advice to go on Coumadin. A year later another EP saw the same charts and disagreed. Also I followed up with about 20 event monitor sessions (lifestar AF - it triggers automatically too when it senses a problem) and all of them only showed sinus pauses. No AFIB. I had an EP study with this new EP doc and he could not induce Afib. He found an atrial flutter under pacing and ablated it. If I am ever in Afib it probably is for a brief while, when exercising. My rate is fine during rest. I can run at 7 min pace for a min or two, or run upstairs without problems. I have never seen a rate in excess of 140 and that only after I have run for a few minutes, starting from rest. My problem is lowered rates after a few minutes of exercise which becomes worse after I stop and I'm just wondering why the conduction system won't work when I'm at rest, just because I exercised an hour or so earlier when it does fine the rest of the time. The docs don't have an answer.

[axg]

sorry make that 8 min pace not 7 - no way. I could barely do that when I was fit 25 years ago.

[runnertom]

Sorry, but I have already given you all I know and some that I am just guessing. In my own case though I often have noticed after a long ride or run that I get inappropriately breathless climbing steps. I'm wondering now whether that could have been Afib that I was not otherwise aware of. When my fib was recently caught on an EKG, my subjective feelings were not that different from the fatigue and sob that I had been attributing to an exhausting workout.

[axg]

Apparently you can still do a hard workout. That's great.  I can't. One question, you have had afib after exercise, is that right? I think you said it was recorded. Your ventricular rates are high aren't they with afib? I know afib means 'regularly irregular' and the rate varies but what you see on a heart rate monitor is high isn't it?

[runnertom]

Yes, I still do pretty intense workouts. This morning, we did 60 miles on bikes with numerous occasions-hills or impromptu bursts-where my heart rate would be bouncing off max (175-180). My Afib was showing up after exercise but I am fairly sure it was beginning toward the end of the workout when I started feeling like I was fading. It persists for 12 hours or so. My heartrate monitor shows ventricular rates that are not that high at rest (~110)but my normal resting pulse is about 45. In my brother's case, his rate would go to 200+ that made further exercise very difficult. His EP said he had a "slicked up" AV node that allowed the fibrillation pulses to get down to the ventricle. Sounds to me like every case is different. Big problem is finding an EP interested enough to work with you. My experience is they are used to working with people who are quite sick and are not too interested in spending a lot of time helping someone who only wants to be able to exercise more intensely.

[axg]

thanks. Both my EP and interventional are now saying I need a pacemaker. The former has been saying that for some time. He has shown interest I might add, but they don't have an EP at his clinic so he has been referring me to others. My EP started with trying another med (flecainide, I've had Toprol,rythmol and Tiazac - all did not help or made things worse) but that apparently prolonged my bradycardia. As you know, there is not much research into the causes of the arrythmias that are presumed to be benign.

[dquenzer]

Does exercise reduce heart disease?  No question.  But I don't think a person has to be a marathoner.  The studies show that one hour or so of light aerobic exercise is about the best; along with weight control.  If one wants to get into shape to run marathons etc. then it's for another reason rather than heart health.

As to heart disease one can't overcome genetics completely.  Jim Fix had bad genetics.  But he probably lived longer and better if hadn't run.

But they've done studies that running probably increases average longevity by about 2 years.  Not really that much.  The real quesiton for me is quality of life.  I want to live a reasonably healthy active life.

I'd rather live 60 good years of activity than 90 years of feeling miserable.  When I see older people who can barely walk up stairs, etc. because of poor health habits I certainly don't want to live like that.

[axg9504]

Well said. That's all that's needed. However it is irritating to see the old geezer next to you running on the treadmill at a pace you know you could double or triple, were it not for your crappy conduction system!

[Angie O Plasty]

I don't blame you for finding that irritating.  It's even more irritating when you know your conduction system is perfectly fine and you're still slower than 90% of the other runners, even the so-called "geezers"!!

[axg9504]

Hi angie! I have to admit I'm old but hopefully not yet a geezer. If you really care and want to, I think you can improve your pace by training. I don't keep up with running anymore, but I bet 'Runners World' has a program for this. I believe that the limiting factor is the type of muscle fibers in your leg muscles. There's a 'slow twitch' and a 'fast twitch' I seem to remember which genetically predisposes you to be either a slow-er runner suited for long distance or one for sprints.

[Bromley]

Hi, these ablations change things.

Am runner had low rates and numerous annoyances for several months after my "successful" ablation for left wall WPW in April 2004.

The effects of the ablation set me back mentally and physically.  It took a while before I could take my heart rate back up into my "performance" region, even without any TOPROL.  For a while I could feel every heart beat when I laid down at night - they were slow and huge - I could literally count everyone of them without taking my pulse, and using my timex the rate frequently was around 40, at times less.

I gave considerable thought to all of this and continued with fairly moderate running program. Eventually, my heart rate returned to something that I would consider a lot more normal. I rarely experience such heavy heart beats at night, unless on that day I have really brutlize myself on an all out run over miles or in snow. I would say that running has helped my recovery immensely.  

Good luck.

http://pages.prodigy.net/edc3/imusa/heart_rates.html

[axg9504]

I don't think my ablation (for atrial flutter they found on pacing) had any negative impact. My symptoms have been consistent for 4 years but have slowly gotten worse or occurred earlier in my exercise routine. Right now @ 7:30 am my bpm is sub 40 while I sit and type this. If I get up and walk around it will go to 60-70 (with SOB). How did this happen? Last night I walked 1.2 miles in about 20 minutes and then worked out for another 15 mts with weights. After I got home my bpm dipped to 50, recovered to normal after about an hour. Last night I woke up at 2:00 am with brady. again and the pounding of every beat as you described. I suspect it will last another hour or two this morning and I'll be fine. Funny thing is if I had started exercising early in the day, I would have recovered and not relapsed.

[axg]

Hope you see this. What was your symptom before the ablation? Did the WPW (Wolf-Parkinson?) produce tachycardia? What's interesting is that you have lower rates after you run (or used to have) like me. Is it confirmed that they were due to the ablation or due to lack of fitness? Did this cause you to get dizzy while running? BTW I use a Timex too.

[Bromley]

hello. Yes, the WPW produced as much as 6 minutes of tachycardia, with rates in the mid 200's.  This occurred after about 10 minutes of running, never at any other time.  At all other times, heart rythmn and rate were completely normal.

I have no proof of the underlying cause for the brady, just some solid personal observations. I do believe though that it is a fairly well established fact that the heart remodels itself (makes some adjustments over time) after an ablation.

Also, I guess as a runner, I tend to be a bit more aware of these things.  With consistant workouts, and over some time, I feel like my heart rates are closer to what they were before I had the ablation.  ~48 at rest, when in shape.   I no longer notice low rates and heavy heart beats when I lay down at night. I am inclined to think that consistant exercise has contributed to a remodeling process that eventually has had a normal end point.

regards