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Exercise Induced Tachycardia

Hi everyone,

Over time I've read many posts about tachycardias and whatnot. I can relate to many, but I'm trying to narrow it down a little more.

I'm a 54 yrs old male, otherwise healthy, but when I exercise I seem to inevitably have an episode of tachycardia. This has happened to me as far back as I can remember. I've read about SVT's and CPVT's and such, but I feel that I fall somewhere in between.  

Generally, I'll be on the treadmill or playing basketball at a decent level of exertion. HR sustained at around 140-150. Then suddenly I feel something come over me, which always serves as a 3 to 5 second warning that it's going to happen, and sure enough, off to the races.. my heart rate spikes for no apparent reason. nothing that I do at that point keeps the episode from happening. It will follow its course, and I just have to wait it out. Thankfully my episodes don't last more than 2 to 3 minutes but they are nonetheless nerve racking. They always signal the end of exercising for that day, or even for a while as I become afraid it will happen again or in a worse way.  Btw, sometimes it also happens in the cool down phase, of say, a 40 minute treadmill exercise.  

Unlike an SVT, by what I read, it is not like a switch that turns on and then off.. it's a bit more gradual, both on the way up and also on its way down. I also don't experience the crazy high HR that gets into the 200's. My heart rate will generally go up about 30 to 40 beats from where the episode started and will take about 30 seconds to get there. Once it plateau's it'll stay there for 1 minute or 2 and then start going back down, but a little slower than it went up. Sometimes on the way down it triggers again but milder.

On the other hand a CPVT is triggered by Catecholamines, one of which is adrenaline. The reason this concerns me is that this one is triggered by exercise and is considered deadly. I want to rule this one out but can't help be concerned. Every time I have and episode it is preceded by what I feel to be a surge of something, perhaps adrenaline overload or something. That feeling ALWAYS triggers a tachycardia.

I've been to the cardiologist and have done and EKG, an Echo and a Stress Test... he found nothing particularly wrong with my heart other than Bradycardia (low resting heart rate) and a very mild valve regurgitation. However, he seemed rather dismissive being that I'm overall very healthy and thought perhaps it was in my head. Ironically CPVT patients will present exactly that way, with structurally sound hearts.          

Anyway, I'd love to hear back from any of you, particularly about any weird sensation(s) seconds before an episode. Or any diagnosis related to Adrenaline, exercise and your symptoms.

Thank you!                
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Avatar universal
Hi Hyperhack!

Yes I can relate!  
I know EXACTLY what you mean as I get the same "feeling" before a tachycardia episode.

Little background, I'm a veteran athlete (36 years) in various sports but the last 15 years in metabolic training (cross of bodybuilding and crossfit).  
8 years ago I passed out after a hockey game (HR was 200+), said I had AF.  3 years later my new best friend is a highly respected cardiologist in Cali who said I dont have AF; put a 14 day tracker on me that caught Sick Sinus Syndrome of long pauses on day 11.  Pacemaker implanted 2017.

Since then, and getting progressive worse is this sequence:  training at about 80% of my capacity, no events, normal for 2 weeks.  Then, espisodes of tachycardia brought on by training more than 15 minutes (either weights or crossfit) exactly as you describe.  Out of the blue I get a nauseated feeling 10 seconds before blast off and then HR starts rising as you stated, up about 30-60 beats but sometimes higher.
This alternates with days where HR is chronotropic, I can do crossfit exercise for 10 minutes continuous and HR not get over 115... and it drops VERY fast (back to 65 for exampe within 25 seconds).  My resting HR is 42, was lower when younger.

This is my life now - somedays I can train almost normal, others tachycardia and then still other days chronotropic.
On tachycardia days if it's bad I have to take a beta-blocker to control....

I have been told I might have Hypervagotonia but no doctors seem to know / understand this.  Every heart test, stress test, EKG, etc. comes back with "your heart is great".... so they shrug and say you're in great shape, don't worry about it.....

It affects me everyday and that seems to ne inconsequential to the medical professionals....... as long as you don't die in their office!

I continue to research and would be happy to share anything I find and vice versa if you would like to.

I wish you the best in health,
Helpful - 0
20748650 tn?1521032211
I would love to see the ECG if you have a copy. You can upload it to a drive and send it to my inbox. Wouldn’t mind taking a look.
Helpful - 0
Thank you!

I don't have a physical copy of my ECG at this moment, but when I do, I will certainly forward it to you to get your feedback.  Thanks again!      
20748650 tn?1521032211
Also I noticed you said you visited an ordinary cardiologist.

Maybe you need to see an Electrophysiologist given that you’re concerned for CPVT. Ordinary general cardiologists really don’t deal with that.

If I had to put money on it I’d bet it’s an outflow tract VT. Maybe some variant of AF/AFL that’s not behaving like it should or something.

In any case I think a more careful workup by an EP is justified. It certainly *sounds* like a legitimate tachycardia.
Helpful - 0
Thank you so much for taking the time to Respond!

I went back to my test results and they show as follows:

Abnormal EKG - Sinus bradycardia rate 51 left axis deviation and poor R wave progression                                                       low voltage left. Nonspecific ST-T wave abnormality present

Trace mitral Valve regurgitation

Trace tricuspid valve regurgitation

Two week monitor results - Brief bursts of SVT 4 beats and 8 beats

Otherwise everything shows healthy, EF of 55%-60% and all measurement within normal range.

My ongoing concern is about that weird feeling that I get right before an episode of tachycardia during exercise. It feels like it could be catecholaminergic in nature and perhaps then leading to a VF event.

I've read many articles/posts about the feelings associated with SVT's and the like, but they are always about the event itself.... feelings of shortness of breath, anxiety, heart jumping out of chest etc. But, my ongoing question other than the possibility of CPVT is, what causes that 5 second warning that I get? What causes that feeling that is a sure fire precursor to an event? And does this resonate with anyone else?

Thanks again.        
Critical rate of induction and some ectopics before it becomes sustained causes some hypoperfusion and a feeling of an impending episode. Alternatively it could just be some latency in rhythm induction to symptom onset.

I think you may be biased toward CPVT. If you had a VF event you would pass out completely. You’d faint, straight to the floor, mouthful of concrete
20748650 tn?1521032211
Interesting! Throwing a curveball this direction aren’t we? Love it!

Apparently I needed to refresh on CPVT. It’s so uncommon that I for one haven’t seen a bona fide case of it and knowledge I could regurgitate off the top of my head from school was somewhat limited.

After some digging it looks like CPVT is highly reproducible. So if you’ve had a stress test after these symptoms set in and didn’t have any tachycardia that’s a highly encouraging sign. Similarly if you have not experienced any fainting or felt like you were about to faint during exercise or emotional distress that is encouraging. If no first degree relative (siblings, parents or children) has experienced sudden/unexplained cardiac death that’s also encouraging.

If all 3 of these things are true for you, the chance of having CPVT are astronomically low. Unless there are details about the timeline or your history you are excluding I’m not sure that’s public enemy #1 here.

SVT I guess is an option but sort of sounds shaky given your description of triggers and such.

I’ll tell you what IS certainly a possibility though? Plane old fashioned ventricular tachycardia is an option. Not necessarily an unstable VT but certainly an idiopathic outflow Tract VT with a critical rate of induction certainly would seem to fit the description nicely. It’s a tad odd that it doesn’t show on a treadmill test but it would also be much harder to reproduce than CPVT and would cause your symptoms. It would be a more common phenomenon as well.

I wouldn’t say that you necessarily need to *worry* too much but I *would* maybe get a repeat holter. Maybe an event monitor or just a longer term 48 hour - week continuous monitoring device to try to nail down what this is. I’d also be interested in the stress test results, what did your PVC burden look like in recovery?

Of course timeline is also important. If you got all this testing done years ago it’s possible that whatever you have has progressed and is now simply easier to find. So perhaps an entire repeat workup would be appropriate in that case.

Helpful - 0

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