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High heartrate, stinging and chest tightness
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High heartrate, stinging and chest tightness

I am a 40 year old female long time triathlete.  I have done many events including Ironman.  My question is when I train whether it be running, swimming or cycling my heart rate is always very high and does not recover quickly.  This has been the case for many years.  I tend to average in the 180's during a workout and go up to 206 when pushing very hard (its been as high as 213).  It can take 10 to 15 minutes for my heart rate to go back down to around 100 (my resting rate seems high for a long time athlete at a average of 70).  When it gets over 200  I sometimes see "glitter or stars" and start to sting all over from head to toe. I also have left side only chest tightness when I go hard.  The stinging only lasts for maybe 10 seconds as do the stars/glitter maybe only 3-5 seconds.  I do not do any herbal stimulates nor do I hardly drink any caffiene.  I never do any type of drugs or alcohol.  Nor am I on any prescription drugs other than birth control.  The only supplements I do is a multi vitamin.  This condition has been going on since I was a teen.  The thing that makes my nervous now is that I get left sided chest tightness when my heart rate goes in the 190 range and it stays tight for several hours.  I also getting a racing heart during rest such as when I am lying down ready to go to bed.  It feels like my heart is going to burst out my chest and gets a flopping over or upside down feeling.  
I had a ekg and ultrasound of my heart both was normal.  I was told there isn't anything wrong with me.  I hear these stories about people dropping dead at the finish line of an event and sometimes worry if something like that is going to happen to me.  I am very competitive and have a high pain tolerance.  I want to continue but would like to know if I am really ok and is this really normal.  Sorry for the length I just wanted to share the whole picture.  Any ideas if this is dangerous or if I can do anything to prevent it?  Thanks so much in advance.
Avatar_dr_f_tn
You seem to be in excellent shape, however your markedly elevated heart rates with the "glitter or stars" symptoms may be a sign that your heart is not able to meet the demands of your body (the increased heart rate is a compensatory response to pump more blood; however the stars/stinging may be a sign that there is still not enough oxygen reaching your brain and toes). Though it seems that you have had this symptom for years and have done fine.

I agree with you that this new symptom of left sided chest tightness is very concerning, as it may represent that your heart itself is not receiving enough oxygen (whether due to decreased oxygen supply from a coronary blockage; or increased oxygen demand from your exercise routine). While the normal EKG and ultrasound are reassuring, I'm assuming that they were both performed in a resting state? If not done already, you should discuss undergoing a stress test with your physician. By monitoring an EKG and ultrasound during peak stress (while you are running on a treadmill), you can get a better idea of whether your heart is hurting from the stress of marked activity. If the stress test is able to elicit your chest tightness, without any change in your EKG or ultrasound at that time, it may be a reassuring sign. If there are abnormalities noted, your physician may recommend a heart catheterization as a definitive way to look for a heart blockage.
3 Comments
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Avatar_m_tn
Thank you so much for your response.  Yes the tests I had were at rest.  I did ask about a stress test but the doctor told me I was fine and joked and said "I don't expect to see you for another 30 years for an appointment if I am still around".  So I just let it go.  But I do know my body and feel something isn't right.  Maybe something is off or maybe I'm fine but I want to be confident that I wont do damage or worse if I push through chest pain becuase of something that was missed.  In a race I will push and go the extra gear with pain or whatever to have a good race outcome (I have almost blacked out more than once at the finish).  In the end my family and my health is most important.  So I assume I need to see another doctor possibly.  I just felt my current doctor was not wanting to do anything further.  

I thought about purchasing a Holter monitor since the my co pay is similair to the cost of one to purchase on ebay.  I could wear it during an intense training session and see what happens.  Would that be good idea?  Thanks again for your wonderful help.  It is very much appreciated.
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Avatar_dr_f_tn
Yes, I do agree with you that your chest tightness does sound concerning and that it does warrant a more extensive work-up before being felt to be nothing of importance.

I wouldn't purchase a Holter monitor for a couple reasons:
1) Holters are more suited towards looking for arrhythmias, and would not be a good diagnostic tool for potential heart blockages (ie it looks at the wiring, rather than the plumbing). In your specific case, it may be more valuable to obtain a stress ultrasound to see exactly how your heart responds under stress.
2) I was not aware of Holter monitors being sold over the counter, and cannot comment on their accuracy. Just as importantly, they should be interpreted by licensed professionals (ie cardiologists, nurses trained in Holter, etc).

I would recommend re-emphasizing the severity of your symptoms to your physician. If s/he is not concerned, consider getting a second opinion. Good luck.
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