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Avatar universal

Palpitations long after exercise

The details:

38 yr old male. 6'3". 175 lbs.
No medications, no "recreational" drugs (ever), never smoked, no caffeine, healthy diet, couple beers a week. No family history of heart problems (to my knowledge).

I've been exercising regularly for about 16 years - weight training and running/x-country skiing (in season)/indoor rowing.  4-5 times per week.  My resting HR is typically 45-50.  

The issue:

Heart palpitations that start 3-5 hours AFTER I finish exercising...most of the time, but not always.  If they appear they'll continue well into the next day (usually) and will gradually go away.  I'll exercise again, and the cycle seems to start all over.  Very annoying and a bit disconcerting.

Tests:

EKG (2)
Treadmill stress
24 hr Holter

All were normal, but I don't think much happened when I was wearing the Holter.

Question:

Should I be concerned?  It annoys me enough that I'm beginning to fear my workouts.  I feel great while doing them, but am afraid of what will happen later on.  

By the way, I have had "anxiety" issues and my wife thinks that it's more related to that than my heart.  Hard to say for sure, but the palpitations certainly feed my anxiety.

Thanks MUCH!
26 Responses
239757 tn?1213813182
MEDICAL PROFESSIONAL
cheeser,

Thanks for the post.

SOund like evrything is ok. If you wanted, an event monitor wouls show you the rhythm when you were having your symptoms. If they are PVCs and the rest of your cardiac evaluation is normal (which it sounds like it was), then you really have nothing to be worried about with your exercise.  

Anxiety certainly can cause a lot of problems.  It is just as important to deal with these issues so that they dont interfere with the rest of your health.

good luckq
Avatar universal
What type of palpitations are you experiencing? "Skipped beats" (PVCs) or a fast heart rate or something different?  I'm just curious because I also have anxiety issues - which causes my heart to race at times while at rest ex 120 beats/min vs. normal resting rate about 55-60.  I also have PVCs and PACs but they are less tightly correlated with acute episodes of anxiety, rather, I tend to have more PVCs after being very anxious - maybe even the next day.
Avatar universal
Hi cheeser,
I experience much of the same.  During exercise, I don't get any palpitations, but afterwards, as you describe, they come quite often.  Mine are such that my heart rate appears to slow down to about 30bpm.  I also get them sporadically at other times, which I can't necessarily relate to exercise.

I also had ECG, holter, and stress test.  All normal.  My PVCs don't occur during exercise at all.  I also had an event monitor, as the doc suggested above.  This is what caught the ectopic beats (or PVCs).  I was then advised that they are benign, and too reduce stress/anxiety and exercise more.  But as you say, it is disconcerting, and makes me fear heavy exertion.

I think an event monitor is a good next step for you.  

My only concern with an event monitor is the fact that (at least in my case), it was only a 2 lead ECG, vs a 12 lead ECG.  Can anyone comment on the accuracy of a 2 lead ECG reading vs 12 lead ECG?  I've read that PVCs can mimic an idioventrical escape rhythm (which makes a lot of sense in my case, since my palpitations are very slow).

Regardless, cheeser, the event monitor would be the first step - you want to a least get these palpitation episodes recorded.

I think I may pursue getting mine recorded with a 12-lead ECG, and get a 2nd opinion - just to ease my mind.  If you are anything like me, the "not knowing" is the worst part of all of this.  We all hear too many stories about sudden heart attacks in seemingly healthly people.  So that 1% (or less) chance of an abnormality is enough for me to push for a definitive answer, even if I appear over-bearing or paranoid to my doctor.  My health and my family's welfare is much more important that my doctor's personal opinion of me.

Best of luck to you,
Alison
Avatar universal
Hi Andie
I just thought I'd let you know that I posted a response to your post from Feb. 19th.  I'm not sure if people ever go back a week later and check to see if there are any new responses to their posts, but thought I'd tell you just in case you hadn't seen it.
Janne
Avatar universal
Isn't it strange? We'd tend to think that exercise might make our palps worse. As for me, even when I have a bat PVC day, they seem to disappear when I'm exercising, which is really wonderful. Then 1 hour or so after my work out, if it was a bad PVC day they will just start again as before, but exercise doesn't always bring them up.

I think  not getting palps while exercising is a good thing; I read it on this board a few months ago.

Cheers

Fran
Avatar universal
Thank you for the reminder and thanks so much for your comments - you were correct that I had not looked back at my post until just now.  I see my cardiologist next week and plan to ask about a cardiac MRI. I'm doing ok, but I am a little afraid to exercise because if I get symptoms I start worringing again.  You mentioned you didn't have any risk factors except smoking - If you don't mind, could you elaborate - Chol, BP, etc. The reason I ask is that my doctors seem to completely rule out CAD based on my lack of risk factors - even though I have unexplained pains. Sorry to take up room on this thread.
Avatar universal
I'm pretty much in constant trigeminy, but during exercise (treadmill), I have, on occassion, decreased to a PVC every 10 or 12 beats, which for me is heaven, so exercise helps me.

It is very disconcerting to have any strange rhythm during or after you have exercised but if you've been given the "ok" by your doctors, I'd second that and say keep on exercising.

Sudden death from cardiac arrest is a very scary thing. My mom and dad both died in their 60's from sudden heart attacks, and my brother had heart surgery at age 42 to correct a faulty valve. BUT, if you are low for all the known risk factors, taking family history and your own health history into account, then you are ahead of the rest of the pack, by miles. There are no guarantees againt SCD with or without the best tests.

I am actually more frightened by motor vehicle collisions--even knowing my family history for heart attacks and myself being in trigeminy. I am however, on the watch for cardiomyopathy, which is the only thing cardiologists have been able to say "may" happen with high frequency PVCs. You've got to be a good consumer of your own health care, so keep on looking for answers until you are satisfied.
Avatar universal
Hi Andie

I don't mind at all that you asked about my risk factors.  Although I do not know the exact figures, I was told  my cholesterol was excellent (I'm lucky in that no one in my family seems to suffer from high cholesterol, so I guess it's not in my genes). Despite my good cholesterol, I was put on lipitor to reduce my LDL even further than it was.  When I had my blood checked, I was told that my HDL was excellent and my LDL was so low it was almost undetectable on the blood test. I'm not so sure that's a good thing being so low, but I have been told that lipitor also has some physical benefits for my heart.

My blood pressure has always been within normal limits, with the exception of when I was pregnant or on the birth control pill, then it was borderline high.  

There is no one in my family that I am aware of who has heart problems. I have one brother with high blood pressure.  My dad passed away at 46 but he was a big drinker. My Mom passed away a few years ago at age 64 from lung cancer.  My grandmother will be a 101 in May and still going strong.

I was a smoker when I had my first heart attack, however, I had quit previously for 11 years and had only been back at it for a few years (stupidly under stress I started back).  
I always felt I was overweight, but I was told I was only about 7 pounds overweight.

The only thing I was really told to do was to reduce stress in my life (which I have). Along with some personal issues, I also was in a high stress job in engineering and development (which I have since quit and gone back to school full time).

No one can tell me where the 90% blockage came from if I don't have high cholesterol.  The restenosis was caused from scar tissue, and the angiogram after the second heart attack showed my arteries completely clear.  

I have been told it is very usual for a woman to have a heart attack at 39 and again at 41 with no real risk factors, but it does happen.  I cannot say I can completely blame the doctors for thinking it was in my head because I passed all the cardiac tests.  What else were they to think?  

I think that it must be very difficult for doctors in these types of situations because there are people who have anxiety issues, and although I had no history of anxiety problems, with all of the stress in my life at the time, it would be reasonable to think I had developed anxiety.  However, as I have heard from the docs on this forum, anxiety should be a diagnosis of exclusion.  Until my family doc mentioned it, I did not know about Prinzmetals angina or variant angina...I really started believing the symptoms were in my head, so much so that I refused to go to the hospital until I was absolutely sure I was having another heart attack...I didn't want to waste anyone's time.

Good luck with your appointment next week.
Feel free to ask me more questions if you need to.
Take care, Janne
Avatar universal
Hi Upbeat! Nice to see your post. I was thinking of you and wondering if your trigeminy had improved. I also thought of you because I had praised Inderal so much that you said you'd give it a try and I praised it too soon...Last night I was having constant bigeminy for hours; took 20 mg Inderal which usually does the trick immediately and nothing happened. Took one more 20 mg, nothing happened. So I went to the ER! It's the very first time I go to the ER for tachy and PVCs. I was monitored all night and ECG only showed tons of bigeminy, no NSVT it seems. The wierd thing is, the cardio said he saw PACs, not PVCs. Weird. I always only had PVCs in my holter taken 2 years ago. Could the doctor see wrong from the ECG? anyway, he discharged me saying the same old wonderful story, i.e. that they're really nothing to worry about. He just ordered a new holter to make sure the medeication works. He prescribed bisoprolol instead of Inderal. Has anyone ever tried bisoprolol? He said it's a new kind of Betablocker. I was very disappointed with Inderal, which I was praising as the miracle cure!
I guess it much depends on the situation, on our general health, etc. So far Inderal had been fantastic for me. Let's see how this new one works.

Upbeat, I'm very sorry to hear about your parents. Anyway you're right: the danger of dying in a road accident is much greater than dying from SCD, regardless of our family history.

Take care and happy arrhythmia free day everyone!

Fran
Avatar universal
Check your electrolytes. I was getting PVCs hours after excercise and found out later my potassium was bottoming out. I didn't have symptoms until after I sweat and lost even more potassium.
Avatar universal
couldn't post on other thread closed. Just wanted to say that i just emailed my cardiologist to let him know that bigeminy rhythm slowing up but i still want them to try and provke them and ablate if they can. I don't think they would not atempt it if they didn't think there was a chance they could do it, a chance i'm willing to take. with all the medication i have been on these passed 6 week make me wonder that when these buggars decide to come on they do, and when they decide to stop they will. in my case i don't think meds has helped much as i'm just back to my 80mg a day what i was taking for years. Just finished vacuming and guess what? (THEY ARE BACK)It's nice looking at all of your post keeps me same being i'm off work at the moment. I'm in London England so with the time difference don't know if your awake or asleep ha ha. take care you all.
Avatar universal
It is frustrating that you can't predict when, or if, the bigeminy will be there, but I'm glad to hear you've gotten some relief.

Do you still have PVCs when you don't get the bigeminy? Are they very many and do you feel them? You don't get the chest pain with the periodic PVCs just the bigeminy right?

I wonder about meds for PVCs. Beta blockers may or may not work, and it could be a matter of which one, so you might have to experiment with your doctor. Toperol may have stopped a bigeminy period for me, but does nothing for the trigeminy! I must say though, that it does work to reduce the sensation of PVCs and luckily it hasn't changed (too much) my heart rate or BP which are just fine. I was worried about being a little tired from the BB, but that seems to have stopped. Anti-arrythmics scare me a little, but are an option for some people.

Have you heard of a date for your ablation yet? Maybe you already posted that. Knowing that your ablation is scheduled is like a type of medication itself isn't it?
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