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My ongoing Heart Saga

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My ongoing Heart Saga

Old 07-24-20, 06:19 AM
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My ongoing Heart Saga

Several years back I posted here looking for answers about a persistent problem. On many days I struggle to get my heart rate up. At about 75% of max or 140/182 I feel destroyed, my left arm starts to feel numb, swollen or tight, and sometimes my heart goes the same way. This can be well after a good 15 minute warmup. I often feel a breakthrough later in the ride where I can suddenly get my HR up. To break down the advice I received here it was basically, You're going to have a heart attack go to the doctor.

About 1.6 years ago I finally broke down and went to the doctor. He ordered an echo stress test and bloodwork. On the treadmill I felt fine and the bloodwork came back with no problems. I decided it was in my head and essentially ignored it. I have experienced the same issue when walking hard up hills or trying to run, which I don't do.

I started my indoor training on Zwift this winter, and it seemed worse that last year, it's always worse at night indoors. I sent emails to several coaches to ask if they had heard of any such problems. I got so many answers back, they ranged from, You're about to have a heart attack, to my splein, to exercise induced asthma, but they all encouraged me to go to the doctor. I went back to the doctor and asked about exercise induced asthma and was given albuterol to try. At first I thought it worked, but it came back.

When Covid hit I decided to take up coaching with someone who gave me a really good response to my question. Since March I've been pretty much riding on a training schedule and training with power. I can generally hit the power numbers I'm suppose to hit, but it's often a struggle that leaves my left arm tight and sometimes pressure in my chest.

Two weeks ago I finally got a consult with a cardiologist.. I was given an ECG and it was abnormal showing a thickened heart since my one 1.6 years ago. He was every concerned about my blood pressure, which I check often and find to usually be around 120/80. At the office that day it was 130/88. He was worried about Hypertrophic Cardiomyopathy ordered a regular echo test and a Nuclear Stress test. He said the echo showed a very healthy heart that had grown 1mm thicker since last year.

I did the Nuclear Stress test yesterday, I was feeling really, really nervous about it, and generally just freaked out. Before the treadmill stress part I had a blood pressure of 157/110 and they weren't going to let me do the test, but I stood up and it went down. As soon as I started running on the treadmill I knew it was a waste of time. I felt perfect, It may sound stupid but I could feel this rush of oxygenated blood everywhere in my body. I had zero symptoms and could have jogged at 85% for an hour if they wanted me too. Though doing it with a mask on wasn't fun.

In my next visit next month the doctor said he plans on prescribing me BETA BLOCKERS, which I said were the opposite of what I was trying to do, I want to be able to get my heart rate up, not down. I think I'm going to discontinue treatment.

Whatever is wrong with me, it's not my heart and when I asked about artery issues the doctor said he didn't think that was a possibility. He said his best guess is that my heart was outstripping my blood supply and essentially outpacing the rest of my cardiovascular system. That's exactly what it feels like.
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Old 07-24-20, 11:02 AM
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Has your doctor listened to your concerns about what is going on for both on and off the bike? Not all doctors fully understand what or why we want to work that hard to ride a bike. My G.P. would be happy if I never got on a bike again. He thinks they are too dangerous. Funny he's never said anything about driving, and I have a history of syncope. But he listens to me and we can have a two way conversation, so for the other things he does, I'm still seeing him, despite his bias against bicycling

My cardiologist seems to be more in tune to at least the idea behind aerobic and cardiovascular fitness and how it relates to cycling and other intense exercise. I'd think your cardiologist would also be so inclined too as such cardio vascular exercise is pretty much related to their field of expertise. So maybe there is a communication breakdown.

If you have a doctor that can't explain things to you and communicate in a two way conversation, you might consider looking for another. Find out which cycle themselves. That will at least give you common ground to have a conversation. Make sure that you aren't the one that is not pulling your side of the conversation. I'm sure many doctors that would talk don't because most of their patients just want to get out of the office with a prescription.

If I don't cycle for a few days to maybe a week or more, I start feel blah and unhealthy. Like you, I start to do something that gets my HR up and I feel great. So that in itself is just a natural and common thing..... I think.

As for not reaching max HR..... How do you know what your max HR is. Formulas don't give you your max HR. They only estimate what it is for the average person of that age. And I think you alluded that you may have had a small heart attack or something. So your max HR may be well different than what is the average.

Did your cardiologist give you any restrictions for getting your HR up or exercise of any sort?
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Old 07-24-20, 11:16 AM
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That's very interesting, well duh, of course. You certainly find it so. I have had something similar for some time. In my case, I feel it as a tightness in my chest, on the left side. It was terrifying when it first started, a couple years ago. I've had the full cardio workup, same result as yours, though I also had the CT scan which found a lot of coronary calcium, which the doctor said not to worry about, not the cause of my problem, and probably will never be a problem. Anyway, my PCP thinks it's a muscle in my chest doing that for unknown reasons, making it difficult to get full breaths until I'm quite warmed up, which sometimes takes 1/2 hour.

For me, 15' is not sufficient for a warmup. I do 20' moderate, than 90" as hard as I can, 3-1/2' moderate, repeat that, and then it's been 30' and I'm fairly warmed up.

Thickened ventricular walls are normal. All of us cyclists who train a lot get them. It's a good thing, increases blood flow.

Sounds like you have White Coat Syndrome with that BP. I have a cycling buddy who has it bad. He got his own BP monitor and takes it himself. I guess you do the same. 120/80 as you probably know is the upper limit of "normal," which probably means what the doctors wish were normal in the US today. Beet juice or its main constituent, inorganic nitrate, will take it down and do no harm. Instead of drinking a lot of expensive beet juice, I just take a gram of sodium nitrate every morning. Same thing.

Do you stay hydrated, that is pee 6-8 times/day? If you do, it's not blood supply. Blood volume is elevated in all endurance athletes. One guess would be my doctor's, that it's some muscle thing. My guess is that it's some venous thing, because you say swollen. Swollen limbs are often the result of the little valves in our veins messing up. You could try doing pushups before you mount, see what that does if anything.
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Old 07-24-20, 02:26 PM
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Iride01 That's funny you mention that, he asked, "WHy are you trying to get your heart rate so high? What exactly are you trying to do on your bike, is this competitive." I told him not exactly though I had raced in the past and would like to race in the future, but essentially I enjoyed riding really hard. I don't think he understood. I'm certain I've never had a heart attack. I've never felt pain or errant heart beats. Just tightness, and a overwhelming need to stop when I know I'm nowhere close to max. My HR hit 190 in a race a few years ago, and if I'm really fired up 180 is possible. Though typically it's around 177. Once my HR breaks past the 145-155 barrier and I'm feeling good it's not usually a problem other than the usual wonderful feeling of burning lungs and burning legs.

Carbonfiberboy Yeah we've talked in the past. Extended warm ups usually help me alot. For example the other day I was going for a 20 minute ftp test and ten minutes in I gave up, felt like my chest was going to implode. I pedaled at 50 watts for about 5 minutes. Then cautiously started another effort. Second effort had avg HR of 165 and 265 watts. I felt amazing, I could have kept going but had to stop at a stop light. My wife is a nurse and takes my blood pressure for me, and we have one of the little automatic devices too. I do stay hydrated. I may just try some pushups LOL. Be alot cheaper. The general solution would be a 30 minute warmup followed by an all out effort until failure, rest and then get on with it.
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Old 07-24-20, 03:11 PM
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If you are able to do things you want to do at the level you want to do them, then having a lower HR is a good sign. It means you are able to pump enough blood without your heart having to max itself out. If you max out your HR, then that becomes a limit for your performance. Right now, other things might be limiting you, assuming there isn't a cardio reason.
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Old 07-25-20, 02:38 AM
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Try the beta blocker for awhile as directed. Shift your training to endurance and strengthening rather than cardio. Give it a few months. Don't stress your heart further. Give it some time, then re-evaluate later.

I take a beta blocker occasionally for migraine and severe headache. For whatever reason these types of headaches don't respond to most pain relievers, but do respond to beta blockers, serotonin reuptake inhibitors, anti-seizure meds and other meds intended primarily for other purposes.

If I take a beta blocker I won't be able to reach my current max heart rate (173, at age 62), for a couple of days after taking a beta blocker. So I switch to mostly zone 2 and longer rides. And I have to go by "feels like," because my heart rate monitor might be telling me I'm in zone 3, but my feels like gauge is saying nah, bruh, this is zone 4.

Suits me for now since it's too hot and humid for hard training rides outdoors. If I feel like doing intervals I'll use the trainer indoors.

Similarly, my immunologist wants me to give up caffeine completely because I've developed an unusually fast resting HR (90s rather than the usual low 60s) and BP (150/90, rather than the usual 120/60) and way too many skipped beats, even at night, hours after my last cup of coffee. I checked the labels on all my foods, snacks and drinks and realized there was caffeine in most of my workout drinks and snacks. So while I was drinking "only one or two cups of coffee," in fact I was taking in the equivalent of more than a pot of coffee a day. So my presumed resting and max heart rates were skewed.

Also, FWIW, I find it easier to stick with my plan to emphasize zone 2 and endurance rides by switching to my hybrid. When I suit up for the road bike my mentality changes and I tend to push harder than I'd planned. But if I wear baggy shorts, a casual fit jersey and ride my hybrid with swept bars, I'll stick to my plan for an easier pace. I did 60 miles that way Wednesday and enjoyed it. Usually on the road bike in summer I'll keep ramping up effort and feel cooked after 20-30 miles.
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Old 08-06-20, 05:18 PM
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Original poster... Has your Dr. checked for Apical Hypertrophic Cardiomyopathy, or other heritable heart conditions which may explain your thickened heart and other symptoms? Some of these conditions are quite rare and even a cardiologist might miss it.
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Old 12-23-20, 06:22 PM
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5 months since my last post. I'm still alive! and I'm still struggling with the same issues.

Shortly after my last post I took a mountain biking trip to Colorado. I had received a call from the cardiologist nurse who said the nuclear stress test didn't show any problems. On the second day had my most epic day on a bike, On August 1st we rode Monarch Crest down and then the road back to the top. 55 miles and 5100 feet of climbing on a mountain bike. It wiped me out. On out last day there I climbed Mt. Mitchel and didn't have any issues with it. I was schedule to go see the cardiologist again sometime in late August but I had returned to teaching and forgot about it. Truth is I decided not to go, I got my bill for the Nuclear stress test and though I only had to pay a percentage the test cost like 12,000 dollars. Feel like I was wasting my time and money.

The cardiologist had already told me, if the nuclear stress test didn't show a problem, and I survived my cycling trip to Colorado he was going to prescribe me beta blockers. I didn't want to take beta blockers as I felt like I wanted the opposite effect. Beta blockers block adrenaline receptors and I and only really feel good when I'm riding on adrenaline. I feel like my body is stuck in parasympathetic nervous system mode. When I had raised these concerns with him he just shrugged and said, "You should take them."

ON August 20th I wrapped up my 3 months of coached training with an FTP test, I averaged 270 watts for 20 minutes.

On August 29th I had my best performance of the year. Went on a group ride, only the third group ride I'd done all year. I did a lesiurely ride to meet the group. There was a 27 year old former Cat1 racer at the ride who was visiting town and taking all the local KOMs. On this ride I had a 159 average Heart Rate and hit 180 once. I stayed with the former racer on all the climbs and dropped him in the flats and downhills. I felt amazing.

September was a recovery month, stopped doing training rides and just rode for fun.

I started Zwift racing in October, easily won my first D class race. A couple days later I did a C class race and did well too with a Normalized power of 271. I've continued doing C class events but power output has been down.

Since then I've been struggling, Yesterday I did a mountain bike ride with a few guys and struggled badly the entire time. Today I tried to ride a local 3 mile climb, and posted my two slowest times up the climb EVER! Both days my average heart rate was only 129 and both rides I felt like I was burying myself just to keep going.

I'd really like to find some kind of physician who was interested in figuring out what is wrong with me. I'm going to ask around for ideas.
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Old 12-23-20, 10:16 PM
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Originally Posted by gattm99 View Post
5 months since my last post. I'm still alive! and I'm still struggling with the same issues.

Shortly after my last post I took a mountain biking trip to Colorado. I had received a call from the cardiologist nurse who said the nuclear stress test didn't show any problems. On the second day had my most epic day on a bike, On August 1st we rode Monarch Crest down and then the road back to the top. 55 miles and 5100 feet of climbing on a mountain bike. It wiped me out. On out last day there I climbed Mt. Mitchel and didn't have any issues with it. I was schedule to go see the cardiologist again sometime in late August but I had returned to teaching and forgot about it. Truth is I decided not to go, I got my bill for the Nuclear stress test and though I only had to pay a percentage the test cost like 12,000 dollars. Feel like I was wasting my time and money.

The cardiologist had already told me, if the nuclear stress test didn't show a problem, and I survived my cycling trip to Colorado he was going to prescribe me beta blockers. I didn't want to take beta blockers as I felt like I wanted the opposite effect. Beta blockers block adrenaline receptors and I and only really feel good when I'm riding on adrenaline. I feel like my body is stuck in parasympathetic nervous system mode. When I had raised these concerns with him he just shrugged and said, "You should take them."

ON August 20th I wrapped up my 3 months of coached training with an FTP test, I averaged 270 watts for 20 minutes.

On August 29th I had my best performance of the year. Went on a group ride, only the third group ride I'd done all year. I did a lesiurely ride to meet the group. There was a 27 year old former Cat1 racer at the ride who was visiting town and taking all the local KOMs. On this ride I had a 159 average Heart Rate and hit 180 once. I stayed with the former racer on all the climbs and dropped him in the flats and downhills. I felt amazing.

September was a recovery month, stopped doing training rides and just rode for fun.

I started Zwift racing in October, easily won my first D class race. A couple days later I did a C class race and did well too with a Normalized power of 271. I've continued doing C class events but power output has been down.

Since then I've been struggling, Yesterday I did a mountain bike ride with a few guys and struggled badly the entire time. Today I tried to ride a local 3 mile climb, and posted my two slowest times up the climb EVER! Both days my average heart rate was only 129 and both rides I felt like I was burying myself just to keep going.

I'd really like to find some kind of physician who was interested in figuring out what is wrong with me. I'm going to ask around for ideas.
Naw, you're dong great. What happens is that athletes get tired, or not tired enough, or whatever.
You just need some metrics to help you figure out why you feel what you feel. I'll tell you what I do.

1) I have a premium subscription to TrainingPeaks and upload every workout from my device. I monitor my CTL, ATL, and TSB in the Performance Manager chart. TP has several articles about what it all means.
2) I take my resting and resting standing HR every morning. Google for how-to.
3) I use the Elite HRV app with my phone. Works off any Bluetooth HRM transmitter.
4) I record my results, together with my morning HRs in a spreadsheet, along with my day's activities. I record all the info which the HRV app shows.

It takes a few months to get a feel for what it all means. To get reliable results, it's important to know what's going on with your physiology, This is probably not a doctor thing, but rather a personal knowledge thing.

Also:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288952/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729801/
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