29 year old - palpitations/arrhythmia from training?

[DimitriB]

Hi all,

I am a 29 year old male and have been doing muay thai for about three years now. My health has always been spotless. In the last couple of years I effectively stopped drinking, ate very health-consciously and have never smoked or did drugs. I trained 5 times a week, about two hours each day. I have never had any issues until June 2014. I started running a lot more to condition myself further before amateur fights. Then one day at the office where I work, I got up to walk to the printer and nearly fainted. For about 4 weeks thereafter, I had walked around slightly dizzy and lightheaded, as if things were not quite moving right around me. My doc put me on a Holter for 24 hours, did the echo - both nothing. My iron level was on the low side of the normal range (46 mg), so my doc prescribed Proferrin, which I took for 45 days. I rested, ate much more, toned down exercise and after about a month I was like new again. I thought I was done with whatever it was.

In early December 2014, I was feeling quite well, running a couple of times a week (about 10km each time - not a huge deal for me: I'd run 17km earlier in the Fall). One day I came back to my desk after lunch, sat down, and all of a sudden my heart rate jumped from area of 60 to something like 150. I had a sip of water, flattened myself which calmed down my heart, but decided to get myself to the hospital. They did an ecg and ran the test which confirmed it hadn't been a heart attack. I did blood work which showed that iron was again in 46 mg area, the echo, multiple ecgs, chest xray - no visible issues. In the last 5 weeks I've had two trips to the emergency room (I had not passed out but I was quite close to it on one occasion). I've scaled down exercise to very mild, twice a week at the most. I thought I just needed to rest and eat well, which I have been doing all of January. Then last night I was in bed at 11:30 PM, with my heart rate slightly elevated at around 80 bpm, then all of a sudden it started speeding up to area of 150, completely unprovoked. Within 40 or so seconds it was back down to 80 area, but in that short period, when my heart was accelerating it felt like it was the end. This had happened once before to me in January already. I am going for a 48 hour Holter tomorrow, and will see a cardiologist but it seems like no one is able to tell me what is wrong with me.

On a few occasions I've experienced shortness of breath, mild discomfort in the chest area, very mild headaches. My family physician thinks because I trained so much I burned off a lot of iron (I also sweat a lot more than most while training, which as I understand, makes me lose iron more). He thinks that even 5 weeks after I started taking iron supplements (2 capsules 11 mg per day), I may still be deficient. I am not anemic (my hemoglobin is normal).

Has anyone had any similar experiences, or heard of endurance training related heart conditions?

Any help, thoughts would be appreciated.

Thank you!
Dimitri

[DimitriB]

Thank you both for your responses. Pacperson, I don't think that I am anxiety-prone. I have nothing in my life to really worry about. My personal life could be juicier but then again, whose couldn't :).

So, on Friday at 2PM, I put on the Holter to be worn for 48 hours. After 5 hours or so, I developed an ache in my abdomen. I went into ER on Saturday morning and they told me that my appendix was inflamed. Later that night I had laproscopic appendectomy (I guess when it rains, it pours). My heart was beating at a normal pace, although with what feels like slightly higher amplitude (where you feel the vibration from the heartbeat in you chest and stomach) leading up to the surgery, even though I was a little nervous. I got back to the office on Wednesday. I felt fine, until 11AM or so, when I felt a tad more lightheaded than earlier in the day, all of a sudden my fingers, hands and toes got cold, I put on a jacket and walked down to the food court to get soup. I stopped at shoppers drugmart to measure my blood pressure, which somehow shot up to 148/90, way to high for me. All this time, the heart was beating at a normal 60-65 bpm. After an hour things calmed down, I warmed up and blood pressure (measured in the walkin clinic) came down. I guess I had a mild fainting episode, minus the heart speeding up.

My doctor is running more tests (potassium, magnesium, thyroid). My iron level is slightly up to 60 mg now (from 46). I am told I should get it up to 80 mg (average for men).

[MichelleP_3811]

You could have some form of svt.  The classic symptom is that it starts and stops in what feels like one beat.  If feels manic and it is hard to breath.  Most feel close to fainting when it happens but they usually don't.  Check into vasovagal maneuvers to try and stop the episode once it gets going.  Bear down and strain like going to the bathroom while holding your breath or try drinking a very cold glass of water.  The only way to know for sure is to catch it on a monitor.  If you don't have them often it can be hard to catch.  You may actually want to try a 30 day monitor as opposed to a 2 day.  That is how mine was caught.  Once caught, if it turns out to be an svt, you may be offered an ablation.  But in general most svts are not considered a danger to you.  They are more a nuisance than anything else though you would not want to let one go on for hours and hours without heading to the er.  But I had my svt my whole life with rates in the 200s and only got it ablated in my 40s when it started to disrupt my life.  For some I have heard that intense exercising seems to kick it in but it isn't the main reason for having it.  If it is typical svt it is caused by some extra heart muscle tissue that is capable of conducting a signal.  And ablation would essentially cut off its access but it does have to be seen for that to happen and the less frequent they are the hard they are to ablate but just keep on top of it and I am sure you will catch it at some point.  Take care and try not to worry.  So long as you are mindful of it when an episode occurs you should be fine.

[pacperson]

I have had endurance training related tachycardia episodes. First in 2007 during a 10K road race, thought I was going to hit the pavement.  I didn't know what it was at the time, and it self-corrected after walking 15 minutes. Next was during a climbing trip a year later. This time the tachycardia did not self-correct, and after a sleepless night worrying, we descended the mountain and I went to ER where I was checked out and admitted. I spent 5 days in the hospital after being cardioverted. Had lots of testing done including an mri which showed no structural problems. Paroximal atrial flutter was the diagnosis. My constant pvc/pac's began then. Then again during an open water lake swim the next year,I went into flutter again, self-correcting after 4 hours. And 2 summers ago again during a difficult pitch of rock climbing. Self-corrected after an hour. It seems for me, there is a physical/emotional stress connection.I have struggled with anxiety and panic for most of my life though, so that doesn't surprise me. I did have a catheter ablation a year and a half ago, and haven't had any more tachy, but the pvc's are bad lately (trigenimy at times)
Do you also get ectopic beats, and are you anxiety-prone ? I think the two are a bad combination.