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New article on heart health in endurance athletes

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New article on heart health in endurance athletes

Old 08-10-21, 08:40 AM
  #26  
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I began to have irregular heart beats a few months back, I really believe that too many HIIT sessions over the winter (4-5/week) brought it on, but who knows. Freaked me out for a while, but I'm now riding all out but keeping it to 30 miles or so on advice of my new Cardiologist. Truth is that I feel great when cycling and, at 68, I'm stronger on the bike then I've been for 20 years. My Holter device recorded lots of PVC's, 23% of my heartbeats. My resting heart rate is in the 40's so they won't dole out the medications they use for AFIB as it would lower my rate further. I'm scheduled to have an ablation procedure in a month. I can't explain it too well, but the beat that you don't feel is likely still a beat, just a light one from the ventricle, I was also concerned about missed beats and that's how it was explained. Also, my monitor will sometimes read crazy numbers, even 200. I've come to believe that it is detecting out of rhythm beats and counting a normal beat twice so it doesn't freak me out as much because I feel fine when it happens. Normally, I can't get over 155 or so on the toughest hill. Biggest effect on me has been a feeling of anxiety where the chest feels like its on too much caffeine even when not exercising. Kind of like a full time adrenaline rush.
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Old 08-10-21, 11:28 AM
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Originally Posted by big john View Post
I had irregular heartbeat/a-fib symptoms in 2017. Doctors didn't help much except to refer me to a cardiologist which the insurance denied. After 2 doctors fighting for 6 months, they relented and approved a consult. By then the symptoms had disappeared.
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again,if it doesn't improve.
Now 80.5 yr old. Had afib for about 25 years, tried all the meds, 5 cardioversions and two ablations, all with temporary success.
had Reveal Linq monitor implanted in my chest and was monitored remotely by my cardiologist.
Got call one day saying my heart had paused for 10 sec with resting HR of 34, so I had better come in and have a pacemaker fitted to keep HR min at 60. Side benefit of this is hardly any afib since. I would recommend anyone with afib taking lo-dose aspirin since prolonged afib can result in a stroke.
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Old 08-10-21, 12:48 PM
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Originally Posted by Artmo View Post
Now 80.5 yr old. Had afib for about 25 years, tried all the meds, 5 cardioversions and two ablations, all with temporary success.
had Reveal Linq monitor implanted in my chest and was monitored remotely by my cardiologist.
Got call one day saying my heart had paused for 10 sec with resting HR of 34, so I had better come in and have a pacemaker fitted to keep HR min at 60. Side benefit of this is hardly any afib since. I would recommend anyone with afib taking lo-dose aspirin since prolonged afib can result in a stroke.
I get a kick of older people who still count half years.

When my mother was in her waning days, being attended to by medical professionals and social workers, she made sure to clarify the point. One attendant would walk in with a new practitioner and say, "This is XXXXX. She is 91 years old." But before the sentence was finished, my mother would interject sharply "ninety one and a half".
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Old 08-10-21, 08:55 PM
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Originally Posted by GhostRider62 View Post
C2-7 are messed up on my neck. I get occipital neuralgia attacks quite often. I occasionally (not often) get Trigeminal neuralgia. The difference is quite simple. With occipital neuralgia, you wish you were dead. With trigeminal neuralgia, you think you ARE dead. This pain makes broken bones seem like a mosquito bite


I recently found a new pain mgt doctor he applied a nerve block to a couple occipital nerves at the base of my neck and the pain was greatly reduced. The next step was RF ablation of those nerves. It is no silver bullet. The cause of the problems are in my neck and that pain still exists, but the pain into the eyes and double vision is pretty much gone at this point. Just sharing in case you were not aware of this treatment.
Very familiar, definitely can relate. It's hard to convey to folks who don't suffer those pains the full extent of what it's like.

My usual explanation is to show them some of my healed breaks and scars from other injuries, including a finger that was crushed in machine and dangling by a flap of skin, blood vessels and nerves -- which was the only reason the finger didn't need to be amputated. The only treatment I got was to splint and bandage it. The finger healed pretty well, although the nail is permanently split and occasionally there's a bit of numbness. But I didn't take anything stronger than ibuprofen. I've had several cracked ribs and a cracked sternum from boxing, motorcycle crashes and road rash and cracked ribs from bicycle race crashes in my teens and 20s. I never even bothered going to the ER because there was no compound fracture, no danger of perforating lungs or internal organs. I knew from my job (Navy Hospital Corpsman) that there wasn't much they could do about cracked ribs. And I didn't want to get written up for disciplinary action for engaging in risky sports off base without permission from the CO. So I just toughed it out. Ditto the cut and bruise under my eye on the cheekbone from a boxing tournament. I just applied a butterfly bandage myself and lied that I fell off my bike during a commute to work.

I don't whine about most injuries and never missed a day's work. I think I went to sick call once in my six years of Navy duty, and that was for an upper respiratory infection -- I didn't want to risk my patients, who were mostly folks with kidney failure, some with compromised immune systems. And I went back to work that day after sick call. I don't know what the military is like now, but back then you didn't even mention being sick or injured unless it was serious, and even then you could expect to be accused of malingering. It was so tough they made our patients get out of bed and make their own beds immediately after surgery, etc. Unless they were dead, in a coma or literally dying, there was zero empathy for our sailors and Marines who were ill or injured.

When I was hit by a car during a bike ride in 2018, my shoulder was broken and dislocated. In the ambulance they offered fentanyl, which I declined. Same with morphine in the ER. I declined and said a single hydrocodone or tramadol would be good enough. However I did joke around that I might want that morphine in a day or so when the pain really would begin to kick in. I got a prescription for 30 hydrocodone, which they labeled as a 10-day supply. I made it last six weeks because I needed it only at night to sleep. It's difficult to objectively compare experiences with pain among different people, but I'd say my pain tolerance is higher than average. That's probably true for many athletes, particularly in combat sports, bike racing, anything that involves an element of risk of painful injuries. Very few people persist in those sports unless they have a pretty high tolerance for pain. So I don't think my pain tolerance is unusual.

So when I say a headache or whatever hurts, I'm not exaggerating. I mean it's intolerable.

Reminds me of how I first heard a doctor (dentist, actually) suggest I be checked out for trigeminal neuralgia.

Several years ago a molar cracked and quickly became infected and very painful. I had no dental insurance coverage and visited the public health dental clinic, which charged a nominal fee for urgent care procedures. I knew pretty much all they did was fillings and emergency extractions, but no advanced repairs or treatments.

It wasn't bad when I arrived pre-dawn (there's usually a line of people waiting) but by mid-morning I was in agony. It wasn't the tooth area or jaw that hurt, though. The entire right side of my head felt like it was in a bear trap with sharpened jaws, plugged into an electrical shock machine -- it was so painful I couldn't touch my scalp or use an ice pack on it. Another patient ahead of me noticed I was in severe pain and asked the nurse to let me in ahead of her.

The dentist couldn't actually do the extraction until early afternoon, but he did immediately inject the local anesthesia in the gums. I noticed that in less than a minute the pain on the right side of my skull was subsiding. The dentist said that didn't sound like a migraine or cluster headache, which he said don't usually respond that way. He asked for my permission to inject more local anesthetic in the rest of the gums and jaw area on the right side of my head, beyond the area of the tooth that needed to be extracted. Of course I agreed.

The pain was completely gone. In fact, I realized it was the first time in a decade that I had zero pain anywhere in my head. I've had chronic and occasionally severe headaches for so many years that it's become background noise. When nurses and doctors ask my pain level and I routinely tell them around 4, 5 or 6, they look at me like I'm lying and trying to mooch opiates. Nope, I'm just telling them honestly what it's like to live with moderate chronic pain. After awhile you can block out most of it, although it never feels good.

But for a few hours that day I had zero pain above the neck. It was like waking up in a new world. After the tooth extraction I felt so good I stopped at the downtown park just to listen to some live music by a local band, watch kids (and adults) play in the splash fountain, and snap photos (I've done candid street and documentary photography for decades and usually carry a camera everywhere). For about an hour it was marvelous. Then I noticed the headache sneaking back in. The dental clinic gave me a prescription with about 10 hydrocodone, so I took one and headed home. By the time I got home the headache had returned to about 75% of what it had been that morning. These usually persist for anywhere from 12 hours to three days -- this one lasted about 48 hours, sometimes subsiding a bit but always returning full blast.

Anyway, I'm considering something like botox injections next time I experience trigeminal neuralgia, migraine or cluster headache. Meanwhile I've tried to identify and minimize the triggers.

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Old 08-11-21, 06:19 AM
  #30  
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Originally Posted by canklecat View Post
Very familiar, definitely can relate. It's hard to convey to folks who don't suffer those pains the full extent of what it's like.

Anyway, I'm considering something like botox injections next time I experience trigeminal neuralgia, migraine or cluster headache. Meanwhile I've tried to identify and minimize the triggers.
My trigeminal trigger is when airplanes descend. Theory is pressure change on a vessel hits the nerve. It happens 50% of the time when flying. The Occipital seems pretty well controlled by the RF ablation from the pain doctor.

I get the same looks from medical personnel when I say my pain is a 5. I did not even use the pain medication after rotator cuff surgery, I finished a 600k brevet with a broken elbow, played in a state championship hockey game as a kid with a broken bone in my ankle, and the ER people did not believe my appendix was the problem (it ruptured) because, "I was not jumping off the ceiling like most patients". I was seeing a Chiro for shoulder PT post surgery and I mentioned to him I had this annoying level 4 pain in my mid back and I usually snap it back in with a really hard sprint up a hill on my bike. He looks at it and says my lower thoracic rib "disconnected", so, he lifts me up like a bear hug and jerks me and there is this loud pop. The pain immediately went away. I said thanks, that was annoying. He starts laughing and I asked why the laugh. He said that is the most common complaint he sees and the lowest he has had a patient score that pain was a 7 and usually it is an 11 with them coming in the door howling. I gave it a 4. I have come to the opinion the pain scale is not linear, it really is logarithmic. And if someone has only felt broken ribs or something like that, they cannot comprehend what nerve pain can feel like. I had one spine surgeon tell me that he does not operate on patients unless they are at least an 11. Basically, he thought I was being a baby with a pain of 6-7.

WRT to my heart stopping, that never happened until I started having nerve pain. I was told it is impossible for nerve pain to stop the heart but every time I wake up due to the heart restarting, I am in severe pain. And, when my pain is in reasonable control, I have fewer episodes of my heart stopping while sleeping.

The best idea I can give someone with some heart issues like in the article is to see cardiologists with an appreciation for those of us who like to exercise. They will thoroughly check you out and if they clear you for exercise, just try not to let it worry you. Easier said than done but that is all you can really do. If they want to do ablation or give you medicine, it doesn't hurt to get a couple different opinions either.
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Old 08-11-21, 10:20 AM
  #31  
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Originally Posted by GhostRider62 View Post
My calcium score is zero and I do not have A-Fib.

My heart stops in the middle of the night many times for 3-8 seconds. (24/7 monitoring for a month on three separate occasions)

I feel quite certain my death will be a not so sudden cardiac arrest while sleeping. I have seen two pulmonologists and four cardiologists.

I have read all the studies. They have no clue nor is there any remote possibility of a clinical study. MI patients on the other hand are big money makers.

I accept it but what I do not accept is the arrogance of the Medical Community. For instance, I have felt my heart stop and told Docs. "No, you cannot feel your heart beat." Me: I can hear it and feel it. "No, that is impossible" When I have felt it stop, I put my little pointer finger onto the that little spot on the wrist and there was nothing. Nothing. I love the word, "idiopathic". It is Latin for, "We have no ******g idea, have a nice life"

In the end, each of us has to make a decision and it comes down to quality of life.
That's hilarious. When I'm in decent shape, that little sucker shakes my chest, blam, blam, blam..When I do deep breathing stuff, I do it by counting beats, so many in, so many out. Don't need to feel my pulse in my wrist.

I also love that word. I also had the heart stopping thing and also wore a Halter. The cardio said don't worry about it, it's nothing. My take is that probably it doesn't like to beat even more slowly, so it just misses a few beats. Don't want to get over-oxygenated, do we?

Yes, it's a quality of life thing. I don't think the number of years is as important as the quality of those years. I'm aiming for a very sharp drop-off. So far I can do anything I want to do, it's just that what I want to do has come down a bit. We no longer do 70-100 mile 10-day backpacks. Now it's only 40-50 miles. I don't ride 400k anymore, now it's just 250k. I started riding mostly tandem, partly because it's harder and partly because I didn't want to race the youngers anymore. I'm comfortable with all that. I know that eventually, like zonatandem, the bikes will be parked, given away, but we'll put that off as long as we can. How we put that off is to eat right and train at least 5 days/week year 'round. We'll know we've done everything we can and had a fabulous life. I don't fear it.

Noticing the additions since I started this post, I once did a 10-day backpack with a torn meniscus. My doctor didn't believe that was possible until I got up on his desk and made him order an MRI. Surgery fixed it. I just kinda drug the leg along behind me. I wasn't going to tap out on that backpack! Had a great time, really.
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Old 08-11-21, 01:59 PM
  #32  
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Originally Posted by Carbonfiberboy View Post
That's hilarious. When I'm in decent shape, that little sucker shakes my chest, blam, blam, blam..When I do deep breathing stuff, I do it by counting beats, so many in, so many out. Don't need to feel my pulse in my wrist.

I also love that word. I also had the heart stopping thing and also wore a Halter. The cardio said don't worry about it, it's nothing. My take is that probably it doesn't like to beat even more slowly, so it just misses a few beats. Don't want to get over-oxygenated, do we?

Yes, it's a quality of life thing. I don't think the number of years is as important as the quality of those years. I'm aiming for a very sharp drop-off. So far I can do anything I want to do, it's just that what I want to do has come down a bit. We no longer do 70-100 mile 10-day backpacks. Now it's only 40-50 miles. I don't ride 400k anymore, now it's just 250k. I started riding mostly tandem, partly because it's harder and partly because I didn't want to race the youngers anymore. I'm comfortable with all that. I know that eventually, like zonatandem, the bikes will be parked, given away, but we'll put that off as long as we can. How we put that off is to eat right and train at least 5 days/week year 'round. We'll know we've done everything we can and had a fabulous life. I don't fear it.

Noticing the additions since I started this post, I once did a 10-day backpack with a torn meniscus. My doctor didn't believe that was possible until I got up on his desk and made him order an MRI. Surgery fixed it. I just kinda drug the leg along behind me. I wasn't going to tap out on that backpack! Had a great time, really.
As a youngster, I met an "elderly" American couple touring France on a tandem. They lamented only being able to ride 40-60 miles per day and having to take rest days and enjoy the museums, etc. They were 76. They were staying at the Youth Hostel and thoroughly enjoying life.
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Old 08-23-21, 11:52 AM
  #33  
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Originally Posted by big john View Post
I had irregular heartbeat/a-fib symptoms in 2017. Doctors didn't help much except to refer me to a cardiologist which the insurance denied. After 2 doctors fighting for 6 months, they relented and approved a consult. By then the symptoms had disappeared.
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again,if it doesn't improve.
You shoud be able to get a monitor for 30 days... Or you could get a Kardia unit for your iphone (a 6 lead system) and record your heart when you feel these symptoms and provide that to a cardiologist for review.
When I was having palpations walking to and from the bus stop and work my primary said it was just gas and recommended prilosec and the like but he would refer me if i insisted. Stupid me I didn't insist right then and it was another 2 weeks when i walked back in, asked for my referral, I got a monitor halter but it didn't show anything. Finally he scheduled me for a stress test, I wasn't 4 minutes into it when he walked in, looked at my rhythm told me to stop. He was going to send me over to the hospital to fill out the paperwork and schedule my cath. I didn't know what that was at 38 but I learned.... turns out I had a 99% block in my LAD (its called the Widowmaker). It had gone on so long that I had new arterial growth attempting to go around it. i got a new Primary doctor after that...
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Old 08-23-21, 12:07 PM
  #34  
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Originally Posted by canopus View Post
You shoud be able to get a monitor for 30 days... Or you could get a Kardia unit for your iphone (a 6 lead system) and record your heart when you feel these symptoms and provide that to a cardiologist for review.
When I was having palpations walking to and from the bus stop and work my primary said it was just gas and recommended prilosec and the like but he would refer me if i insisted. Stupid me I didn't insist right then and it was another 2 weeks when i walked back in, asked for my referral, I got a monitor halter but it didn't show anything. Finally he scheduled me for a stress test, I wasn't 4 minutes into it when he walked in, looked at my rhythm told me to stop. He was going to send me over to the hospital to fill out the paperwork and schedule my cath. I didn't know what that was at 38 but I learned.... turns out I had a 99% block in my LAD (its called the Widowmaker). It had gone on so long that I had new arterial growth attempting to go around it. i got a new Primary doctor after that...
This happened when you were 38 years old?

I don't have an iphone, or any cell phone. Don't have a Garmin or any electronics on my bikes.

The heart rhythm thing seems better and if it doesn't go back to normal I will go back to the doc. It had been 4 years since I had these symptoms.
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Old 08-24-21, 03:31 AM
  #35  
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I am the only one of my family (four of us after mom an dad died) that has not had the procedure for afib. I occasionally get a rapid heart rate of about 115-130 when I’m just relaxing at home after work. My watch notifies me with a slight vibration. I have been checked out by a cardiologist but that was years ago when I told my GP about my family’s heart history. Since my twenties I have always had a very low resting heart rate and low blood pressure but the doctors have attributed that to my higher level of exercise. The last time I talked to my Dr. about it I showed him my phone which stores data from my watch . Using the time frame of my last long ride he could tell when I was climbing and really pushing and then when on the flats just cruising. He didn’t see a problem . I know what my two brothers and my sister have gone through and I don’t think mine is as bad so at 66 I will continue to monitor on my own . Walking a mile or two every morning and cycling a couple of times a week is just fine . If I don’t want to push , I don’t.
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Old 08-24-21, 05:33 AM
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I think the "missing" heart beat thing is PVC or premature ventricular contraction. The electrical signal arrives to the left ventricle from somewhere other than the SA node and before the LV has filled with blood. So when the ventricle contracts from the spurious electrical signal, there is no blood to push out into your arteries and you do not feel the pulse with that beat. I get them at rest if I do too much high intensity work. I also get them on a stress test on the treadmill but only as the heart rate starts to ramp up, say at 100-100 bpm and then they are gone. When I get them, it is every fifth beat. Laying off the double espresso, wine, stress, and not too many HIIT sessions is what I do to control it. If I do to much intensity, the proclivity to faint rears its head or lowers it to the floor.

I am pretty sure I do get PVCs on the bike some days. It is like my six cylinder engine is missing one cylinder. It shows on the HR vs Power curve.

The great thing, I do have a great cardiologist and electrophysiologist. Both respect the exercise and neither consider treatment to be in my best interest. I also got other opinions that were the same. I had all sorts of blood work and imaging tests. Definitely something for an MD to check out thoroughly. I almost wish they gave me a pacemaker or did RF ablation for peace of mind but in the end, you have to trust them and just live.
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Old 08-24-21, 02:51 PM
  #37  
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Originally Posted by GhostRider62 View Post
C2-7 are messed up on my neck. I get occipital neuralgia attacks quite often. I occasionally (not often) get Trigeminal neuralgia. The difference is quite simple. With occipital neuralgia, you wish you were dead. With trigeminal neuralgia, you think you ARE dead. This pain makes broken bones seem like a mosquito bite


I recently found a new pain mgt doctor he applied a nerve block to a couple occipital nerves at the base of my neck and the pain was greatly reduced. The next step was RF ablation of those nerves. It is no silver bullet. The cause of the problems are in my neck and that pain still exists, but the pain into the eyes and double vision is pretty much gone at this point. Just sharing in case you were not aware of this treatment.
Also a long time 24/7 trigeminal neuralgia sufferer. Had a MVD - lasted 3 years. I went through all the meds (I was so overdosed, I was trembling),
ended up with a gamma knife procedure, which didn't work, and a second gamma knife procedure, which did work. However left me totally numb on the right side of my face, teeth, lips, tongue. But it's far better than the absolutely and totally horrendous pain of trigeminal neuralgia.

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Old 09-01-21, 07:22 PM
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Originally Posted by terrymorse View Post
On a subject near and dear to our hearts (literally), Sweat Science author Alex Hutchinson has just written a new article in Outside entitled:

________

There’s New Evidence on Heart Health in Endurance Athletes

After years of debate on the dangers of “too much exercise,” researchers sum up the state of current knowledge
________

The concluding paragraph:

________
Overall averages don’t tell the whole story, of course. Maybe running lots of ultramarathons adds a few months of life expectancy for 99 percent of us, but shortens it by a decade for an unlucky fraction of a percent who have some sort of underlying issue or genetic predisposition. That’s why this research continues to be important, in the hope that we can eventually figure out what those red flags might be. In the meantime, if you’re playing the odds, I’d suggest you keep running, swimming, and cycling to your heart’s content.
________
Pretty much the same conclusion as this study of XC skiers. This is a fairly new report but I've seen this data in the past. https://www.ahajournals.org/doi/full...AHA.118.039461
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Old 09-01-21, 08:19 PM
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Originally Posted by GhostRider62 View Post
My calcium score is zero and I do not have A-Fib.

My heart stops in the middle of the night many times for 3-8 seconds. (24/7 monitoring for a month on three separate occasions)

I feel quite certain my death will be a not so sudden cardiac arrest while sleeping. I have seen two pulmonologists and four cardiologists.

I have read all the studies. They have no clue nor is there any remote possibility of a clinical study. MI patients on the other hand are big money makers.

I accept it but what I do not accept is the arrogance of the Medical Community. For instance, I have felt my heart stop and told Docs. "No, you cannot feel your heart beat." Me: I can hear it and feel it. "No, that is impossible" When I have felt it stop, I put my little pointer finger onto the that little spot on the wrist and there was nothing. Nothing. I love the word, "idiopathic". It is Latin for, "We have no ******g idea, have a nice life"

In the end, each of us has to make a decision and it comes down to quality of life.
Seems like a pacemaker would be a good alternative. There are various types which have different features.
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Old 09-01-21, 11:41 PM
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this is a topic which is near and dear to my heart, literally, as one of the fraction of a percent of people for whom extreme cardio is not just “possibly bad” but demonstrably catastrophically bad. the science around my condition is evolving, and in the short time (9 years) since I was diagnosed, the medical understanding of it has changed greatly. In my case, genetic mutations (dozens have been identified) cause the heart to develop scars and fatty inclusions during what would normally be the healing/recovery/strengthening period after extreme stress on the heart muscle. those scars or fatty bits then disrupt the electrical system that makes the heart beat regularly, resulting in anything from PVCs (annoying in small quantities, harmful and debilitating in large number) to ventricular tachycardia to ventricular fibrillation and sudden cardiac death. the irony is that if you even if you have the genes, never exercised hard, your heart would never develop the issues.

what has changed most in the 9 years is the broadening of the understanding of this particular cardiomyopathy from one caused by a very few mutations and mostly affecting the electrical workings of the heart and almost entirely only one chamber of the heart to a range of related degrees of disease causes by dozens of different mutations and often affecting the heart much more broadly. nonetheless, the first indicator, partilcularly in young people, is often death.

the article and discussion is interesting, but alongside the unknowns about the effect of a ton of exercise on normal hearts, it is worth noting or reminding everyone that if your heart rhythm is irregular or otherwise abnormal (typically accompanied by light headedness, fainting, a feeling of pressure in the neck, anxiousness, palpitations, sweating, etc) you should get a referral to an electrophysiologist ASAP. I was 36, immediately got an ICD, meds, two emergency open heart surgeries at 37, multiple defibrillations and hospitalizations and procedures and new meds and fainting and medical drama of many kinds.
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Old 09-04-21, 09:20 AM
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Originally Posted by mschwett View Post
this is a topic which is near and dear to my heart, literally, as one of the fraction of a percent of people for whom extreme cardio is not just “possibly bad” but demonstrably catastrophically bad. the science around my condition is evolving, and in the short time (9 years) since I was diagnosed, the medical understanding of it has changed greatly. In my case, genetic mutations (dozens have been identified) cause the heart to develop scars and fatty inclusions during what would normally be the healing/recovery/strengthening period after extreme stress on the heart muscle. those scars or fatty bits then disrupt the electrical system that makes the heart beat regularly, resulting in anything from PVCs (annoying in small quantities, harmful and debilitating in large number) to ventricular tachycardia to ventricular fibrillation and sudden cardiac death. the irony is that if you even if you have the genes, never exercised hard, your heart would never develop the issues.

what has changed most in the 9 years is the broadening of the understanding of this particular cardiomyopathy from one caused by a very few mutations and mostly affecting the electrical workings of the heart and almost entirely only one chamber of the heart to a range of related degrees of disease causes by dozens of different mutations and often affecting the heart much more broadly. nonetheless, the first indicator, partilcularly in young people, is often death.

the article and discussion is interesting, but alongside the unknowns about the effect of a ton of exercise on normal hearts, it is worth noting or reminding everyone that if your heart rhythm is irregular or otherwise abnormal (typically accompanied by light headedness, fainting, a feeling of pressure in the neck, anxiousness, palpitations, sweating, etc) you should get a referral to an electrophysiologist ASAP. I was 36, immediately got an ICD, meds, two emergency open heart surgeries at 37, multiple defibrillations and hospitalizations and procedures and new meds and fainting and medical drama of many kinds.
Sounds scary, but how common is this condition? Also how did you come to get diagnosed? Presumably you were suffering from some of the symptoms you mentioned after high intensity exercise?
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Old 09-04-21, 09:25 AM
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Originally Posted by PeteHski View Post
Sounds scary, but how common is this condition? Also how did you come to get diagnosed? Presumably you were suffering from some of the symptoms you mentioned after high intensity exercise?
not common - one in every couple thousand people. more common in people or southern european descent… but it’s responsible for more than 10% of sudden cardiac death cases in young adults and typically manifests in healthy people in their prime recreational activity years, 20-50.

i was getting dizzy/light headed after long/hard runs. ignored it because i was generally very healthy, assumed i was just dehydrated or something. wife finally forced me to go to a doctor after a couple particularly notable episodes.
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Old 09-04-21, 09:34 AM
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Originally Posted by mschwett View Post
not common - one in every couple thousand people. more common in people or southern european descent… but it’s responsible for more than 10% of sudden cardiac death cases in young adults and typically manifests in healthy people in their prime recreational activity years, 20-50.

i was getting dizzy/light headed after long/hard runs. ignored it because i was generally very healthy, assumed i was just dehydrated or something. wife finally forced me to go to a doctor after a couple particularly notable episodes.
Thanks for explaining. Definitely something to watch out for. I'm 53 now and have a long history of thrashing myself pretty hard! So hopefully I'm not one of those unlucky few with this serious condition.
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Old 09-05-21, 10:09 AM
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Originally Posted by PeteHski View Post
Thanks for explaining. Definitely something to watch out for. I'm 53 now and have a long history of thrashing myself pretty hard! So hopefully I'm not one of those unlucky few with this serious condition.
it's rare - no need to worry if you have no symptoms or family history. my dad presumably had the same condition, didn't manifest until his mid 50s, but he was an all american lacrosse player in the 60s, ran and played basketball much of his life, etc. we both came from the school of "if you don't feel like you're about to die, you're not pushing yourself hard enough!"

when he started having issues the science wasn't far enough along to identify it as a genetic condition, so no alarm flags were raised for my brother and i.
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Old 09-07-21, 11:52 AM
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Originally Posted by mschwett View Post
it's rare - no need to worry if you have no symptoms or family history. my dad presumably had the same condition, didn't manifest until his mid 50s, but he was an all american lacrosse player in the 60s, ran and played basketball much of his life, etc. we both came from the school of "if you don't feel like you're about to die, you're not pushing yourself hard enough!"

when he started having issues the science wasn't far enough along to identify it as a genetic condition, so no alarm flags were raised for my brother and i.
You just never know what is around the next corner! No symptoms for me, but I have been thinking about it ever since reading this thread, lol!
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Old 06-07-22, 01:47 PM
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Originally Posted by MinnMan View Post
Regarding the point of the OP. Hell yeah, I'm going to ride. Maybe there's a small added risk to my heart, but there's surely an even bigger risk of serious injury in a crash. Not that I'm reckless- I try to be careful in every way I can, but riding is way too important to me. I'd rather have a shorter life that I enjoy by doing plenty of riding than a very long life sitting on the couch. And I doubt that the latter would be a long life because my mental and physical health would surely deteriorate without riding.

​​​​​Regarding big john , yeah, I feel for you. Both because of the weird heart things and especially because you aren't easily getting the care that you should be getting.
I may have symptoms similar to yours, I dunno. Up until 10 years ago, I could rev my heart in intervals as far as it would go and it would be just fine. But starting in my early 50s, I find that when I get my HR up "too high" too quickly*, I have this terrible feeling of malaise and feel the need to urgently get the HR down. This coincide with an unfortunate change in my heart rate recovery. Previous to this, after getting up to Z6, my HR would go right down by 50-60 bpm in the following 60 seconds. Ever since, it doesn't. It doesn't go own at all for the first 10-15 seconds after an interval ends, and after 60 seconds, it's gone down by 20-35 bpm.

I've had pretty much every kind of test, carried that 24 hour monitor that records everything, etc. Never been able to reproduce it in a way that the doctors could detect. An no doctor (I've seen multiple cardiologists, pulmonologists, etc.-_ I do have good insurance) has heard this description and identified a recognizable medical problem. And never had any evidence of afib. But it comes back - particular doing intervals - and I just hate it.

But I haven't stopped pushing myself or going full gas when I'm able, and nothing really bad has happened. Except that obviously, it limits my athletic ability during hard efforts. So maybe it's harmless. Or maybe one day I'll drop dead on the bike.

*"Too quickly" I can get the malaise by doing 60 second intervals (60 seconds on/60 seconds off) at 140-150% of FTP, and the feeling may show up at 170 or 175 bpm, say after the 4th or 5th interval. But if I'm putting in a hard steady effort at 120% FTP, I can go for 5 minutes and my HR will go up to 178 or 180 bpm, without the malaise.
I found this post while looking at heart-related issues (I had a couple irregular beats a while back, and probably more, but PCP and echocardiogram are not scary)

I brought this thread back from the dead, because what you describe here is something I have experienced a couple times. The first time, I was trying to beat my PR on a 5 mile segment, with no warmup. I figured I'd just use the first mile or so for that. The last mile is about a 2% gradient, and I was pushing fairly hard, feeling otherwise fine, till my HR went over about160, and I felt something like you describe - my desciption would be "not at all well", definitely feeling like I shouldn't keep going at that level of effort. I backed WAY off, and the feeling passed fairly quickly. I went on to ride about 20 miles that day, and pushed even harder up the opposite side of that same gradient (also about 2%) and ran my heart rate up to over 170 without anything like the same feeling. I put it down to not enough warmup.

A couple months later, I was doing a Ramp Test on Zwift. I had done one previously and I wanted to see whether I could go higher. Zwift suggests you don't need to warm up for the test, since there's a 5' free ride segment and then the ramp starts slowly, so I tried that. Just about the time my HR hit 160 or so, I had that same feeling, "Not at all well", "This can't be good", and as you say, the need to stop. SO I did, and at a much lower power than I'd done previously. Then, like the previous time, I kept riding, including a segment where I ran my HR up to 167 without any recurrence of that feeling. A week later, I did another ramp test, this time with at least a 10 minute warmup, and went much higher, topping out my HR at 172, with no 'malaise'.

SO, it sounds like we had the same thing happen to us. I also seem to recall you and I both experienced unexpected changes in our HR zones - significantly lower HRs at the same power output, well below what each of us had ever seen in decades of cycling, right? And nobody had an explanation for that, either.
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Old 06-07-22, 01:56 PM
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Reading GeneJockey's account above, I wonder what is a typical warmup period of time? I never warm up less than 30 minutes before doing a max effort, usually 40 minutes is about right. I have not done any longer tests this year and plan to do a longish climb tomorrow. I've always saw that I performed better and assumed the legs open up but maybe it is the heart. Also, the longer warmup seems more important as I age. No idea why. Heart? Veins and capillaries take more time to dilate due to less NO2?
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Old 06-07-22, 04:33 PM
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Originally Posted by genejockey View Post
I found this post while looking at heart-related issues (I had a couple irregular beats a while back, and probably more, but PCP and echocardiogram are not scary)

I brought this thread back from the dead, because what you describe here is something I have experienced a couple times. The first time, I was trying to beat my PR on a 5 mile segment, with no warmup. I figured I'd just use the first mile or so for that. The last mile is about a 2% gradient, and I was pushing fairly hard, feeling otherwise fine, till my HR went over about160, and I felt something like you describe - my desciption would be "not at all well", definitely feeling like I shouldn't keep going at that level of effort. I backed WAY off, and the feeling passed fairly quickly. I went on to ride about 20 miles that day, and pushed even harder up the opposite side of that same gradient (also about 2%) and ran my heart rate up to over 170 without anything like the same feeling. I put it down to not enough warmup.

A couple months later, I was doing a Ramp Test on Zwift. I had done one previously and I wanted to see whether I could go higher. Zwift suggests you don't need to warm up for the test, since there's a 5' free ride segment and then the ramp starts slowly, so I tried that. Just about the time my HR hit 160 or so, I had that same feeling, "Not at all well", "This can't be good", and as you say, the need to stop. SO I did, and at a much lower power than I'd done previously. Then, like the previous time, I kept riding, including a segment where I ran my HR up to 167 without any recurrence of that feeling. A week later, I did another ramp test, this time with at least a 10 minute warmup, and went much higher, topping out my HR at 172, with no 'malaise'.

SO, it sounds like we had the same thing happen to us. I also seem to recall you and I both experienced unexpected changes in our HR zones - significantly lower HRs at the same power output, well below what each of us had ever seen in decades of cycling, right? And nobody had an explanation for that, either.
Yes, it sounds similar. But whatever it is, it seemingly is not known to cardiologists.
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Old 06-07-22, 04:46 PM
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If its not killing a lot of people it is unknown to cardiologists... the primary focus of the field is on avoiding death since a whole lot of people die from heart issues. These days individuals are getting a lot more data from their HRM etc so are much more aware of all sorts of often minor glitches that can happen. I personally have a strange thing where my heart will sometimes just bump up 10-15 bpm from where it "should be" given the effort I am putting in. And sometimes it bumps up even more, and then I get that "not well" feeling and ease up. It usually happens about 10-20 minutes into the activity. Too much sugar/caffeine and/or lack of hydration are usually a factor.
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Old 06-09-22, 03:06 PM
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Originally Posted by GhostRider62 View Post
Reading GeneJockey's account above, I wonder what is a typical warmup period of time? I never warm up less than 30 minutes before doing a max effort, usually 40 minutes is about right. I have not done any longer tests this year and plan to do a longish climb tomorrow. I've always saw that I performed better and assumed the legs open up but maybe it is the heart. Also, the longer warmup seems more important as I age. No idea why. Heart? Veins and capillaries take more time to dilate due to less NO2?

If you watch pros before a TT today they typically warm up for 20-25 min. It used to be 45 min to an hour. They also used fans and ice vests to keep from overheating. When I went back to riding a lot in my mid-50's I found that 45 min. is what I needed before a significant effort. The Zwift "you don't need to warm up" thing is BS and dangerous. The only time you should do something like that is for a stress test whiled being fully monitored at a doctor's office - preferably one in the same building as a hospital with a great cardiac care unit.
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