BeastMode

I'm seeking information for my brother who was an enthusiastic cyclist and recently had a very serious medical emergency.

He's 30 years old. He went into sudden cardiac arrest while at home some time ago. His girlfriend found him and was able to provide CPR and get him assistance quickly. While in the hospital, he had several more episodes of ventricular tachycardia and cardiac arrest, including one in the emergency department lasting more than 10 minutes. All of these events required CPR and defibrillation (12+ times). Somehow he survived with low brain impact.

Probable cause for the cardiac arrest and v-tach was hypokalemia (low potassium), as it was measured at 1.6 mmol/L (normal range is 3.6 to 5.2 mmol/L). This could not be confirmed and so they installed an ICD (implantable cardioverter-defibrillator).

He does have damage to his heart.

The doctor has now cleared him for exercise, including cycling, but his heart rate should not be allowed to get above 200 bpm due to the presence of an ICD.

The magnitude of the damage is such that a pre-cardiac arrest FTP of ~300 W has dropped to maybe ~40 W presently.

I was curious if anyone has knowledge of something like this, because right now it seems hopeless for him. Is there any advice I can give him?

Maelochs

Tell him to ride his bike.

Whatever he could do in the past is irrelevant. For whatever reason, his heart malfunctioned---he is EXCEEDINGLY lucky to be alive and extremely lucky not to be half-vegetable.

If he has to keep his heart below 200 bpm ... well, that shouldn't be hard. Howe many athletes ever hit 200 bpm? Maybe he won't be racing Pro 1/2 but there is no reason he shouldn't enjoy cycling ... and in fact, Every reason to keep riding. If he lets his body fall apart now the rest of his life will be one day worse than the last--mentally and physically.

He needs exercise and he needs enjoyment. Yeah, he has lost some while Nearly Dying Repeatedly----surprise, surprise. But he didn't die and there is no way to know that he can't gain back all of what he lost. I'd say he has a long, slow rehab ahead of him, and it won't always be fun ... but it will suck incredibly if all he does is think about his "Glory Days."

He needs to face that he is one of the very lucky few to survive that sort of thing---and of course, was unlucky enough to have it happen, but seriously ... I have a friend who had a similar experience who lost some metal function and about half the use of his body---and he realizes he was lucky.

I sympathize with your friend, and I am not sure I would be strong enough to bounce back, but if he has the kind of strength to cycle like that, he probably has the strength needed to change his outlook and accept what he has lost ... and to regain as much of it as he can.

I am really lucky. I just had A-Fib. I only had one really scary near-heart-stoppage event and I had the least-invasive heart surgery imaginable. My heart still messes with me a lot, but it is starting to improve a little (after a few years.) I know a little about what your brother might be going through, but only the tiniest portion of it.

Even so, I can say this: he needs to be fit physically, mentally, and spiritually to get through life. He obviously has the strength if he wants to apply it. There is no limit to what he can accomplish----there are people with no legs who can outride me. Your brother can go as far as his will and imagination can take him. He will need to be patient and tolerant of himself and his new body, but he can still live an amazing, interesting, exciting life and probably help others with his experiences and the wisdom he gains from them.


Your brother has essentially been given a second life. Not a lot of people get that. I hope he lives it to the fullest.

Dan333SP

Not sure if it's caused by a similar condition, but I know @jtaylor996 has a doctor ordered heart rate limitation and may have some advice for your bro.

What was his pre-episode max HR? I'm 30 as well and I haven't seen anything over 185 for a few years, so a 200 bpm limit would have no impact on me.

BeastMode

Thank you for the nice reply, Maelochs.

Dan, as for the max heart rate pre-episode, I believe he could push it to 195+ with a maximal effort on a hot Phoenix day. That's obviously a special case, and I think 185 like you said seems more normal. But it could be that with heart damage, he could now push it higher than that more easily. At least, that's a concern that I have. Maybe it doesn't work that way.

jtaylor996

No, my heart thing is different. I'm at risk for Vfib (aka sudden cardiac death).

Still, I have to live with a heart rate limit as well. Risk for me goes way up when I'm above 90% of max HR (I'm 34, so my max is 186... I have to stay under 167).

Get a good HR monitor (chest strap, optical is not up to medical snuff), computer/watch to display it and keep an eye on it.

Pacing is going to be really hard. It is for me, especially on the hills. I just got a power meter and this helps me pace things up the hills so that I don't end up blowing up my HR too much.

For now I'd suggest getting him on Zwift. It's way easier to manage the HR on the trainer with power data. And the FTP Builder workouts really work. In a few months I had a 20% improvement in my FTP... and managed all of that without getting my HR too high. There's really no reason to get anywhere near your max HR in training (Friel agrees), so a structured training program is his best bet.

jtaylor996

From what I figure, 200bpm is where his ICD will kick in and do a cardioversion. It should be set so this only happens above a normal max HR, but I'm sure there's some overlap in there where it might go off during hard exercise. Obviously, you want to avoid having a machine stop and restart your heart until you're damn sure it's necessary.

deapee

A healthy heart more than likely isn't going to go above 200...we have no idea what his heart is going to be doing. If it's having trouble pumping blood to vital organs, it's going to keep speeding up. As the muscles use more and more of the blood flow, the reserve for the brain and organs is going to be diminished, so the heart will beat faster.

He'll know A LOT more once he has his heart rate strap on and gets on the bike what his heart is going to do. None of us have any clue.

jtaylor996

The real question is if his ICD is Ant+ compatible. For what those things costs, it better be

FBinNY 

I'm sure his cardiologist has a cardio-rehab guy he woks with. That's the place to start, working woth someone who understands the damage, and has some insight into the actual limits and risks involved.

In a sense a strong cyclist is at greater risk than someone who was sedentary all his life. His heart was weakened by the event, but the rest of his muscles are far less affected. That means there won't be upper limits to his effort level based on the legs crapping out, so he has to establish and monitor his heart's working levels.

besides working with a pro, the only advice I have is to take it slow, staying within lower limits, then open taps slowly when he has a sense of what he can and can't take.

BeastMode

You know, on the ICD demo unit that was given to my brother, it's clear that Medtronic's marketing team got involved. Its features include "SureScan(tm) Full Body MRI", "PhysioCurve(tm)", and "SmartShock(tm) 2.0". A fourth line with "ANT+ compatible" seems right at home. That was totally a misstep to leave it out.

Jseis 

I'm 61 and had a few years of arrythymia in my late 40's-early 50 s that was eventually (took 5 years) brought under control by diet & exercise. Doctors orders: Limit time at max HR (170) to 17 seconds if I really feel I must go that high. End result is I spend more time sub 160-161 and rarely go above 165 and even less rarely 170. I don't race, ride mostly endurance but also intervals, modest hills. One of my cardiac incidences about 8 years ago was classified as a near heart attack with no permanent damage. I really watch the over training as it just takes longer to recover. When I started cycling in earnest 6-7 years (post heart diagnosis) ago I doubt I could've produced 40 watts. It scared me to death to ride hard, up hills, fast, breathe hard. But slowly I improved. Took 3 years to get the gumption up to ride the STP and I nearly wept when I finished and my family was there to greet me. I now know my limits and ride within them. I get enormous satisfaction out of any bicycle ride. I got there by way of many small goals linked together.

kostyap

Testing yourself in situations like this on trainer is not bad idea but I would suggest any other software that would not tempt him to chase that other sucker who just passed by.

rpenmanparker 

Post myocardial infarction nearly 20 years ago my max average speed on flat courses dropped from 20.0 mph to about 16-17 mph. Heart rate is partially controlled by a beta blocker, so now I cruise at 135 bpm instead of 150 at age 68. During a test recently, however, I found that my power output without beta blocker at the higher heart rate was very similar to with beta blocker at the lower heart rate. So my speed losses are simply due to the heart muscle damage I sustained during the attack. Not much can be done about that. Ejection fraction is low at 43%, but not critical.

My point is that your brother should expect some performance loss, but enjoyable cycling may still be possible. Just not with the A group.

deapee

Someone above had a pretty good point with working with someone familiar with his condition to monitor as he starts out.

In fact, if for some reason that's not an option, I'd almost head to the local gym and start out on a bike there. That way if you drop, you're not home alone.

jtaylor996

That's why I suggest he do the structured workouts on zwift, not just ride around and race other people. If you're doing intervals, you don't care about what anyone else is doing.

corrado33

I'd just set a HR alarm (all the decent HR monitors have them) for 5 BPM below the limit. Stop doing exercise if the alarm goes off.

JohnDThompson 

And you really don't want to be riding your bike when it fires because you will go down.

Maelochs

My fiend with a pacemaker says it is a heck of a jolt----agreed, not something conducive to safe riding.

I like the trainer idea, and even better the trainer in a gym ... the gym I attend has the bonus of being right next door to the fire station in case I overcook it.

Since my surgery I have seen heart rates as high as before (well over 200, peak of 237) but I have learned to moderate my exertions and some days I can go hard and never crack 160, which about right for my weight and fitness level. Some days I can top 200 easy but I am finding that as I get more fit, my HR drops more quickly so if I go too hard I don't have to quit anymore, now I can just ease off.

Your brother has a completely different ailment, though, so I have no idea how his heart might react. he might not have a heart rate problem at all, and diminished capacity might be the issue. In any case, I hope he can still enjoy cycling.

JohnJ80

Obviously this is a serious medical condition that has some serious underlying issues. A heart attack in a 30 y.o. is highly unusual.

Don't seek or take advice from an internet forum. Do this in close consultation with serious medical experts and his cardiologist. Lots of people return to active lives so it's well understood how to go about doing that and planning for it. on the other hand, one likely consequence of following incorrect advice is death. So do it right.

J.

Maelochs

I am not just a doctor but i will give you bad advice over the Internet ... so maybe I am a WebMd?

FBinNY 

The internet and forums like this are fine for getting the big picture. But people and their conditions are unique and though similar can be very different. The OP's brother has a serious condition with serious implications if he gets carried away and pushes too hard in his efforts to get as close as possible to his prior condition.

We can give some general ideas, but he has to get the specific information from his medical team, and if he lacks confidence in them find a new medical team to review his case history and offer their expertise.

My standard answer to those who try to apply general medical advice to their specific condition is here.

Maelochs

OP never said his brother got hit by a car ....