Tachycardia and Irregular Beats While Exercising

[tgerman1029]

I´m a 36 year old male that is having episodes of tachycardia.  I am a cyclist and up until a couple of years ago I was an elite cyclist racing here in the States and in Europe when an overuse injury with my knee put an end to my career.  About two years ago I was riding my bike and I did a training interval, for ten minutes I had my heart rate between 170 -174.  The interval went fine, but as I was cooling down getting my heart rate back down to 100,  getting ready for the next interval my heart rate shot up to 190, without the corresponding effort output.  It stayed that way for about 10 minutes and then dropped to 88 suddenly.  This kept happening so I went to the cardiologist, who prescribed a lot of tests.  I took blood tests, Holter monitor, event recorder, echo, and exercise stress test.  All showed nothing.  As an athlete I am acutely attuned to what is going in my heart as my training has depended on it, and it is beating correctly, entering into arrhythmia with exertion.  The doctor concluded nothing was wrong. This has left me not being able to exercise and being scared.  It doesn't happen every single time but the majority of the times when I am riding my bike, sometimes it will shoot up to 230 for a few minutes and then drop to 80-90. I am now going to Med School in Costa Rica and I went to another cardiologist.  He listened to my heart and heard the skipped beat that I experience all the time.  He put me on Digoxin (6 drops a day) and Amiodarone (3 half pills a day) and told me not to exercise at all for a month.  I can't tell if it is working but I still experience an irregular beat.  My resting heart rate now is 48-50 and max is ~194.  My heart just doesn’t feel “strong” anymore. 1)  What is going on? 2)  What are my options as far as treating it? 3)  Will I ever be able to compete again?  

Other info:
5'10"
145 lbs.
Diet:  vegetarian, and sometimes bad, but mostly good
Don't drink
Don't smoke
2 cups of tea a day
Stress:  high
Todd

[aom28]

A related discussion, How are your doing, Todd? was started.

[scouser costa rica]

Sorry it did not work out with Fanny,although private medicine costs here are lower than the States.Any chance of using the Social Security,assuming you pay their quotas.Inversonesboricu at gmail.com.
           Saludos Ian

[tgerman1029]

Hey Ian,

We´re practically neighbors.  Unfortunately your email was starred out so I can´t email you but I spoke to Fanny and, unfortunately, she gave the price for the procedure and there is no way I can afford that.  Needless to say but I am very upset by this when I know that there is a solution out there to my problem and I can´t do anything about it to return to competition, or just being active for that matter.  Today I was moving furniture and the high heart rate and arrhythmia stayed with me for a while.

I am trying to see if there is anything else I can do in order to get this test done, any other suggestions?

Thanks for your help Ian, I really appreciate it.
Todd

[scouser costa rica]

Hi,
    A heads on your progress would be good. I live in Rohmoser San Jose.
                                              Saludos Ian
E-Mail  ***@****

[googlybear]

hi buys, im a twenty year old female and for the past few years ive been having fainting episodes during basketball matches.  It has only happened in matches and not training which suggests to me perhaps adrenaline has a part to play or maybe im over exerting myself. I train a few times a week and also do horse riding so im fit enough.  What generally happens is, I get a fluttering or vibration feeling in my mid chest, get dizzy and black out, this generally doesn’t happen mid sprint but just after I stop running, I can then feel the fluttering converting back into a beat a minute or two later. Ive been to the hospital about it, had ECGs, EEG, 24 hr holt, Echo, two stress tests, MRI, tilt table, all inconclusive, and I now have a loop recorder in my left shoulder for the past two months.  I tried to bring on an episode while running but was unsuccessful but I started back at basketball this year and it happened again last week during out first match.  Its not stress related as I love the game, wasn’t nervous and also it was the end of the match and we were way up with points so there wasn’t much pressure on but I felt the flutter again, had to be subbed off and sit down.  I activated the recorder so hopefully now we can find out what the cause is but my next consultation isn’t until January.  Does anyone have any idea what this could be and should I continue playing basketball in the meantime?  During the vibration feeling I tried to feel my pulse and felt nothing but didn’t totally black out, just was dizzy so maybe it was just a weak one…

[dquenzer]

I was an avid runner and cross country skiier until I was about 39 when I started to get irregular heart beats (PACs primarily).  When I was 45 I woke up with an irregular beat that was AFIB.  To make a long story short I had AFIB bouts for about 3 years.  Tried different meds to keep me out of AFIB, but none worked.  Went to a physician at Mayo and he stated that highly conditioned athletes are more susceptible to arrythmias because they tend to stretch the pulmonary veins and have larger hearts. This gives more opportunities for accessory pathways to develop.  I had an ablation to isolate the pulmonary veins and some other accessory pathways that caused flutter.  It worked very well.   I now work out at moderate levels.  I am AFIB free for now.  But I also decided that maybe more is not better.

The answer to how can this suddenly appear is probably a result of your conditioning and training like mine was.  My brother who is also an avid runner developed Afluter.  His cardiologist said it was also probably a consequence of his conditioning.    Not all runners and athletes get arrythmias, but there is a good deal of data that states highly conditioned athletes have a higher risk of some arrythmias developing especially if there is a familial dispostion toward it.

[tgerman1029]

Hi Ian,

Thanks for referral, I will look her up on Monday and see what she suggests.  The Clinica Biblica is in San Jose right?  By the way where are you located here in Costa Rica?  Right now I´m in San Pedro (in San Jose) but I am moving soon to Grecia.

Do you ,or does anyone, how this ARNVT can suddenly appear?  And is it dangerous if I continue train and this keeps happening?

Todd

[scouser costa rica]

You are right.Here like everywhere else we have good and bad doctors
                                                                           Rgs Ian

[scouser costa rica]

Todd,
       Suggest you contact Fanny Rojas at the Clinica Biblica.Their cardio dept has a series of specialists.The comment in the US was by doctors of Leachman Associates, by Dr Agelini and his EP who I dont remember his name. These are some of the best in Houston,according to the man who was then the President of my parent company.I was CEO of a very successfull major food company for several decades so they want to look after me.Not very modest on my part but we were number one in Central America and sold our products in 15 countries.Good for stress!!!
                                                        Regards Ian
PS  I had my pacemaker replacement done here and not in Houston

[tgerman1029]

Thank you Doctor and everyone fro your replies, I really appreciate the help.

Now, I'm scheduled to have another Holter Monitor test this week, the problem is since I am not exercising I am not experiencing the arrhythmia and I doubt the test will show anything.  Is there any other way to show that what I am indeed experiencing is AVNRT?

My question about the EP study is will it definately show AVNRT or some problem or is there a good chance that they won't find anything I will continue to have the problems (this seems to be the standard way of doing things for me, very frustrating)?

Another thing is I don't know how easy it is find a some place to get EP study done here in Costa Rica.

About the meds, I must admit that I'm pretty ignorant about them.  Why is it such  strong medications?  What are the side effects?

Thank you everyone,
Todd

[tickertock]

Please note: I'm aware that Costa Rica has some of the world's top doctors including cardiologists.I'm just stating my personal opinion from the little I know about arrhythmias & various medications. I think a consultation with a good EP is in order and I stand by my statement that amiodarone and Digoxin together especially is an overkill for "certain" arrhythmias, but I would not second guess your doctor as I'm not an MD myself,This is my opinion only.

[scouser costa rica]

Hi,
   I am living in Costa Rica,and by sheer coincidence was a racing cyclist in my early twenties. I rode for the Liverpool team in the UK.I have LAF since I can remember,although in the late fifties I had no idea what it was and it never affected my racing as we did not use pulse meters in those days,and I guess I just rode through it. Ignorance is bliss?
I am now 71 and about ten years ago after my morning run,now with a Polar,I realized that my pulse rate was not going back to NSR so I went to the ER of the Clinica Biblica. My cardio was Dr Fanny Rojas,and has been for the last decade,she is great.My company had me travel to St Lukes in Houston and had Fanny travel with me. The cardios there said that they could not have done a better job than she did and that with her looking after me in Costa Rica there was no need to go to Houston.
        Could not ask for better references so you may want to check her out.
                                                 Good luck
                                                               Ian

[maggiemag]

I would also be very wary of a doctor that puts you on Dig and Amiodarone so quickly without all the proper testing and indication.  Giant red flag, IMO!

[tickertock]

I agree completely with Dr. MJM, an EP study would give you an answer and probably cure the problem, I used have episodes such are you are speaking but they were few and far between, I consulted with EPs & cardiologists who concluded my main problem was probably a mild case IST with PVCs & episodes of PVCs, but also suggested it was possible that I might have a concealed accessory pathway that can sometime masquerade as sinus tachycardia unless an Ep study is done, I don't think I had one attack of tachycardia while on atenolol(beta blocker) though still the occassional PVC(knock wood) almost not worth mentioning, if I ever get these episodes again it is my intention to have an Ep study to completely rule out any other problem. Good luck & I urge you to strongly consider DR.MJM reply ( in my opinion and I'm no MD. Digoxin & amiodarone is an overkill for certain arrhythmias).

[Michael J. McWilliams, M.D.]

Hi Todd,

If I saw  you in clinic I would do an EP study.  You have classic symptoms an arrhythmia.  An EP study involves putting several large IV's in your leg and taking catheters to your heart.  Using the catheters to stimulate your heart, it is possible to induce the arrhythmia and perform maneuvers to make the diagnosis.  The likely possiblities are AVNRT, less likely AVRT with a concealed accessory pathway, atrial tachycardia or an exercise induced VT.  The fact that it started suddenly and terminated suddenly suggests a re entrant arrhythmia and puts AVNRT on the top of the list.

This is a very curable problem and would not require to take any medications long term and you would be able to compete/train the next  week.

I do not like having young people take medications like amiodarone unless they have too.  If an ablation can cure the problem, you will not need to take these medications.

The irregular beats you are having might be unrelated --- premature ventricular or premature atrial contractions.  It would take a holter or event monitor to capture one of these events to know for sure.

I recommend that you see a cardiac electrophysiologist and discuss the option of an EP study to diagnose  your arrhythmia.

I hope this helps and that you are able to return to competition soon.