Exercise Intolerance

Question

Hello!  I could really use some advice.

I am 47, female, non-smoker.  I have always been very athletic - run, lift, swim, cycle 5-6 days a week.  Since my early 20's, when I really started running regularly, I have always had to stop a few times during my run, because my heart rate gets so high, and I am completely breathless.  Once I take a break and walk a bit, then I can resume for another mile or so.  Lather, rinse, repeat.  Two required breaks on a 3.5 mile run.  So, this has been an issue with my CV conditioning for over 20 years.  I have never been able to increase my tolerance, no matter how much I train.  This elevated heart rate ONLY happens when I am doing some very strenuous cardio activity.  I do sometimes get lightheaded when I stand, but otherwise, my heart rate is totally normal.

In my early 30s, I was diagnosed with PVC's.  Nothing that has ever required treatment, and it affects me rarely.

My resting heart rate is about 65-70 bpm.

Recently, I have taken up mountain hiking, which I LOVE.  There is one part of the mountain that is straight up for about a 1/2 mile, and although my body feels strong enough to tear it up, my heart beats out of control, and I have to stop to catch my breath (at least two times).  I would easily say my heart rate gets over 200.  Even when my breath comes under control and I'm no longer panting, I can still feel my heart beating wildly.  I will stop and rest for about a minute or so, my heart rate comes down, and then I continue on (again, I love to exercise!!).  While this "episode" is occuring, I also feel lightheaded and a little dizzy, but never pass out, nor need to sit.  I have gotten used to walking it off, or stopping until I recover and then I can continue.

Last year, my brother had heart surgery for a congenital mitral valve issue.

My concern now is that I may have something similar and it has never been diagnosed?  I have told every doctor I've had since I was 25 about this, and they all say the same thing - that this is "normal" for me.  Which, it can be.  And that would be fine.  I just don't care to crap out on the side of a mountain because I'm doing something I enjoy and feels great.

Anyone else suffer from exercise intolerance?  I'm thinking it might be time to see a cardiologist, just to ease my mind.

MichelleP_3811 · Answer

Cardiologist do seem very blase about heart issues.  I am sure they try to refrain from getting overly alarmed simply because they know the heart is strong muscle as well they have seen everything and a lot of our symptoms though disconcerting aren't overly dangerous but it is good to get checked out to be sure. If it does become apparent to you that this fast beat start and stops on a beat be sure the tell them that.  But if it is a gradual rise and fall and your stress and echo tests come back fine then you very well have nothing to worry about.  Do let us know how it all comes out.

Beaniegirl · Answer

Just a quick update...

I saw a cardiologist this morning.  He seemed pretty non-plussed by my symptoms (which was calming).  He heard no murmur, and the EKG he did was normal.  He's sending me for an echo and a stress test next week, but he said he didn't expect to see anything.

I think this might come down to this being my reality...

Beaniegirl · Answer

Yes, I'm going to set an appointment.  From some of the responses here, it's clear it *could* be something more than "my normal".

I'll report back.

Thanks again, everyone.  :)

MichelleP_3811 · Answer

Just go and get checked out.  Better to be safe than sorry.  I would stress that it gets into the 200s since that is where the pace starts to get concerning.

Beaniegirl · Answer

To the other posters...thank you for your comments (and to everyone, actually!).

When I had the PVC's diagnosed almost 20 years ago, I wore a Holter for 24 hours.  My heart went from 48 when asleep, to 212 when I went running.  Of course, I was in my late 20's, so everything was in better shape then - lol, but there was nothing unusual then that required follow-up.

I have an insurance plan in which I can go to a specialist on my own without a referral.  Do you guys think I should just make an appointment with a cardio, and have them run the full battery?

I'm really only concerned because of my brothers congenital issue, and I don't want to give myself a heart attack while exercising.  Otherwise I'd assume the docs were right, that this is my "normal".

Beaniegirl · Answer

Yes, that's pretty much what I've had to do.   I can run for about a mile, then I have to walk for a quarter.  My time for 3.5 miles is still about 33 minutes, even with the walk breaks (two of them).  On the hiking trail, no one passes me, except possibly on that one straight up section.  I will fall behind people in front of me at this part, but once I get my wind back, I end up passing every one, even with my walking speed on the trail (it's 2 mountains, up and down each side).

Beaniegirl · Answer

Yes, that's how my brothers was diagnosed. I have told every doc over the last 20 years about this, and no one has progressed me past a stethoscope and one EKG (which was normal). I've never had a doc think this was unusual.

MichelleP_3811 · Answer

A good indication of whether or not it is an accessory pathway svt is if the manic beat starts and stops within one beat.  It will not rise or fall gradually.  Though your heart rate may stay a bit elevated it is a sudden rise and a sudden fall in beats per minute that indicates an accessory pathway svt.  I would do as Tom suggested and get a monitor to catch exactly what it is.  It would probably be good to know what type it is regardless if it is or isn't fixable just to be certain it isn't something like afib.   Take care.

tom_h · Answer

"I would easily say my heart rate gets over 200"

You really need to measure your heart rate by palpating your wrist or neck and count the beats.

I agree with the previous post.  If this is a repeatable occurance, you need to wear a Holter or a long term monitor to actually record this phenomonon you're experiencing.  Once observed, if you have one of the different types of SVT, int is in most cases easily cured

littlegreenman1 · Answer

I respectfully disagree with Michelle here.
Sounds like typical exercise induced SVT here. 
Look at my picture - that's a Garmin HR from a particularly bad run I had.

Go to your PCP - have him/her order a 24 hr holter monitor.  If this is a one to one relationship (happens every time) go out there and get the event to happen. If they diagnose you with SVT - get it ablated. Just be prepared to pay your maximum out of pocket for your insurance this year. Call the insurance and find out that number - it's not your deductible - it's more.

After my ablation I went out and hit it hard. I do aggressive speed work twice a week and have 5 marathons on a (previously) similar heart to yours.

MichelleP_3811 · Answer

Very strenuous cardio activity can stress out the heart.  A good way for someone who has issues with going full out with their carido is to alternate between heavy and light.  Slow your running speed down a bit to more of a jog and then every 4 or so minutes go full out for 30 seconds.  Do this 5 times I believe makes for a good workout.  Ultimately it may be that your heart/body just has a tipping point and can't tolerate extreme exertion like others can but do go and get your heart checked out to be sure it is sound and healthy.

itdood · Answer

If you have a leaky valve your doc should be able to hear it as a murmur.  Perhaps you could make an appointment with your primary physician and start from there?  It's always a good idea to get a physical once per year, just bring up your concerns and go from there.