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Mystery for the Heart Rhythm Experts
Hello everyone, I'm a long time lurker on this forum and have come to know that there are a few well-versed patients on this forum particularly Arthur, Hank and Momto3. There are others but their names escape me at the moment.
Anyway, I have a bit of a mystery for you guys involving my heart (obviously). I'm 28 years old, fairly athletic, male.
Last year in October I had to have an ablation due to paroxysmal atrial fibrillation; my pulmonary veins had a lot of active nodes that needed ablated and were. Fast forward to now, I barely have PACs, or PVCs (never had many PVCs anyway, mostly PACs even the pauses), I run 7 miles a day, have been running for years, and only get some bumps as I start my work-out but as I'm running for the most part I have none at all. There are days where I think I'm more fatigued, didn't get enough sleep, fighting a cold, and or some other thing and I'll have a few more during my run than usual but they only come with a sensation no trouble breathing, no dizziness.
This has been ongoing since the ablation, I mentioned it to my electrophysiologist and he thought it was the initial burst of adrenaline needed pre-exertion that was causing them in the beginning, and thus caused them to go away for the most part during the run. He didn't seem concerned, and it made sense to me.
More recently though, on top of running 7 miles I've started playing hockey again, twice a week. As I'm sure some of you know hockey is a very intense sport. My heart hates it, I get PACs during the game. From what I can tell when I am able to check my pulse it doesn't feel like any kind of couplets or triplets; just the extra beat mixed in with the expected faster heart rate from exertion; (beat beat beat beatbeat beat beat beat beatbeat).
This is the mystery, I am doing my best to not let it bother me and years of dealing with these have left me pretty callused. I haven't stopped playing hockey because of them, don't plan on it, but there is a slight concern there since they are really only happening during hockey.
My theory is that my heart is conditioned for long distance running, and these quick bursts of skating, and adrenaline are what is bringing on the arrhythmia and that once my heart is use to this new type of exertion they'll gradually go away.
A couple of things to note:
1.) When I'm in the thick of playing I don't really notice them, so I'm not having any extra symptoms. Its mainly after the play when I'm drifting along and catching my breath.
2.) I still do get occasional bad days during rest with my arrhythmia, but nothing like it use to be. Still though definitely equally as bad as when I get them during hockey.
3.) When I first started playing hockey again two weeks ago the arrhythmia wouldn't stop after I was done playing, it would take a couple of hours and go away. Even after the game. Now it stops after I'm done.
4.) As far as my vitals and medication go. My last blood pressure reading was 111/79; I do take 25mg Toprol XL once a day to manage very mild hypertension that I think is probably under control now since it seemed to be anxiety based during my fear of heart problems phase.
I'm not overweight at all 136 @ 5'7; I try to eat things that are anti-inflammatory because I believe a lot of the arrhythmia issues come from inflammation, so my diet is good, I do treat myself on occasion so I don't fall off the wagon.
I've had every test you could possibly think of except for a thallium-based stress test; did have a normal stress test though. Everything came back normal, except when I was in A-Fib of course :P.
I guess I'm just worried my heart has changed since my surgery, and now I've got some sort of HCM. Trust me when I say this though, the concern is not crippling me mentally. I just like to be informed, and reassured.
Thanks in advance!
Anyway, I have a bit of a mystery for you guys involving my heart (obviously). I'm 28 years old, fairly athletic, male.
Last year in October I had to have an ablation due to paroxysmal atrial fibrillation; my pulmonary veins had a lot of active nodes that needed ablated and were. Fast forward to now, I barely have PACs, or PVCs (never had many PVCs anyway, mostly PACs even the pauses), I run 7 miles a day, have been running for years, and only get some bumps as I start my work-out but as I'm running for the most part I have none at all. There are days where I think I'm more fatigued, didn't get enough sleep, fighting a cold, and or some other thing and I'll have a few more during my run than usual but they only come with a sensation no trouble breathing, no dizziness.
This has been ongoing since the ablation, I mentioned it to my electrophysiologist and he thought it was the initial burst of adrenaline needed pre-exertion that was causing them in the beginning, and thus caused them to go away for the most part during the run. He didn't seem concerned, and it made sense to me.
More recently though, on top of running 7 miles I've started playing hockey again, twice a week. As I'm sure some of you know hockey is a very intense sport. My heart hates it, I get PACs during the game. From what I can tell when I am able to check my pulse it doesn't feel like any kind of couplets or triplets; just the extra beat mixed in with the expected faster heart rate from exertion; (beat beat beat beatbeat beat beat beat beatbeat).
This is the mystery, I am doing my best to not let it bother me and years of dealing with these have left me pretty callused. I haven't stopped playing hockey because of them, don't plan on it, but there is a slight concern there since they are really only happening during hockey.
My theory is that my heart is conditioned for long distance running, and these quick bursts of skating, and adrenaline are what is bringing on the arrhythmia and that once my heart is use to this new type of exertion they'll gradually go away.
A couple of things to note:
1.) When I'm in the thick of playing I don't really notice them, so I'm not having any extra symptoms. Its mainly after the play when I'm drifting along and catching my breath.
2.) I still do get occasional bad days during rest with my arrhythmia, but nothing like it use to be. Still though definitely equally as bad as when I get them during hockey.
3.) When I first started playing hockey again two weeks ago the arrhythmia wouldn't stop after I was done playing, it would take a couple of hours and go away. Even after the game. Now it stops after I'm done.
4.) As far as my vitals and medication go. My last blood pressure reading was 111/79; I do take 25mg Toprol XL once a day to manage very mild hypertension that I think is probably under control now since it seemed to be anxiety based during my fear of heart problems phase.
I'm not overweight at all 136 @ 5'7; I try to eat things that are anti-inflammatory because I believe a lot of the arrhythmia issues come from inflammation, so my diet is good, I do treat myself on occasion so I don't fall off the wagon.
I've had every test you could possibly think of except for a thallium-based stress test; did have a normal stress test though. Everything came back normal, except when I was in A-Fib of course :P.
I guess I'm just worried my heart has changed since my surgery, and now I've got some sort of HCM. Trust me when I say this though, the concern is not crippling me mentally. I just like to be informed, and reassured.
Thanks in advance!
I'm no expert in this, but as no one has responded yet, I'll add my 2 cents worth...
First, I have heard often from post ablation patients that while the original arrhythmia problems may be gone, or improved, many patients may experience new, different or additional arrhythmia or palpitation symptoms, either directly after, or quite some time after, the successful ablation treatment. They seem to go on living their lives to the fullest extent, but just thought you might like to know that not every ablation patient ends up totally symptom free.
Second, there is some interesting evidence (and inconclusive at this point) that endurance athletes may be more prone to some types of arrhythmias and in particular to A-Fib and Pre-mature beats (PVCs/PACs). While this appears to be inconclusive and I don't think they are sure why this may be so -- or even IF it is so -- there is some speculation that the endurance activity itself may be "modeling" the heart to have abnormal beats OR that there is simply a subset of endurance athletes who may be predisposed to A-Fib and arrhythmias and the endurance training exacerbates this. Please note, this is NOT to say that your good exercise habits are the cause of this or that you should alter them, but I have seen it mentioned enough to raise the issue since you asked and it is something you might consider addressing with your cardiologist. From what little I know of exercise and PVCs/PACs, they do, as you mention, seem to be aggravated by "cold" starts and stops or bursts of effort as might be experienced in playing hockey.
Third, there are a few intriguing reports linking cold temperatures, especially breathing cold air or drinking cold drinks, with an increase in arrhythmia symptoms and I am assuming you are breathing cold air in the hockey rink. I think it is speculated that somehow this may cause a slight increase in catecholamines or some other naturally occurring biochemicals in the body that can affect heart rate and electrical conductivity. Since, as you mention, adrenalin can definitely set off palpitations and arrhythmia, the combination of the cold in the rink and the adrenalin of those exciting hockey games might also be exacerbating symptoms.
Lastly, while Toprol can be an excellent drug for several symptoms (that is what I take for my arrhythmia) it is my understanding that in some patients it may actually cause and increase in palpitation symptoms as it slows certain types of conduction which may give more time for PACs/PVCs to arise.
You report good test results, sound quite healthy and seem remarkably well adjusted to this, but If you continue to be concerned, you might consider seeking another opinion from an arrhythmia specialist who specializes in treating athletes. I believe there are a several here in the US.
First, I have heard often from post ablation patients that while the original arrhythmia problems may be gone, or improved, many patients may experience new, different or additional arrhythmia or palpitation symptoms, either directly after, or quite some time after, the successful ablation treatment. They seem to go on living their lives to the fullest extent, but just thought you might like to know that not every ablation patient ends up totally symptom free.
Second, there is some interesting evidence (and inconclusive at this point) that endurance athletes may be more prone to some types of arrhythmias and in particular to A-Fib and Pre-mature beats (PVCs/PACs). While this appears to be inconclusive and I don't think they are sure why this may be so -- or even IF it is so -- there is some speculation that the endurance activity itself may be "modeling" the heart to have abnormal beats OR that there is simply a subset of endurance athletes who may be predisposed to A-Fib and arrhythmias and the endurance training exacerbates this. Please note, this is NOT to say that your good exercise habits are the cause of this or that you should alter them, but I have seen it mentioned enough to raise the issue since you asked and it is something you might consider addressing with your cardiologist. From what little I know of exercise and PVCs/PACs, they do, as you mention, seem to be aggravated by "cold" starts and stops or bursts of effort as might be experienced in playing hockey.
Third, there are a few intriguing reports linking cold temperatures, especially breathing cold air or drinking cold drinks, with an increase in arrhythmia symptoms and I am assuming you are breathing cold air in the hockey rink. I think it is speculated that somehow this may cause a slight increase in catecholamines or some other naturally occurring biochemicals in the body that can affect heart rate and electrical conductivity. Since, as you mention, adrenalin can definitely set off palpitations and arrhythmia, the combination of the cold in the rink and the adrenalin of those exciting hockey games might also be exacerbating symptoms.
Lastly, while Toprol can be an excellent drug for several symptoms (that is what I take for my arrhythmia) it is my understanding that in some patients it may actually cause and increase in palpitation symptoms as it slows certain types of conduction which may give more time for PACs/PVCs to arise.
You report good test results, sound quite healthy and seem remarkably well adjusted to this, but If you continue to be concerned, you might consider seeking another opinion from an arrhythmia specialist who specializes in treating athletes. I believe there are a several here in the US.
Hey! Thanks for the response, I have a feeling that it is really to the cold starts and stops you mentioned also. I also have noticed my breathing isn't as fast as I think it should be during exertion, it is almost like my long distance running is working against my short bursts of exertion. Its like I'm not breathing fast enough to compensate for my heart rate because I'm conditioned to need less oxygen yet, my heart still needs it. Not sure if that is possible, but that is what it seems like.
Basically I feel great and can last multiple shifts in hockey, but my heart is coughing and sputtering. One game I paid close attention to my breathing the entire time, and had only a few PACs. It is a mystery to me at this point, doesn't really scare me. But does concern me a bit.
I've also noticed that I usually get "gassy" too, when they start up during the games. Maybe it is really just a lot of adrenaline and nerves from playing hockey again after 10 years.
Aside from all of that, I've averaged 2 goals, and 3 assists per game so .. they aren't holding me back too much ;).
I'll have to look into these arrhythmia specialists who focus on athletes.
I also agree on the Toprol, I have a slow resting heart rate as it is.. and I think Toprol makes it harder for my heart rate to get up to where it should be during exercise. Maybe that is part of the problem too?
Basically I feel great and can last multiple shifts in hockey, but my heart is coughing and sputtering. One game I paid close attention to my breathing the entire time, and had only a few PACs. It is a mystery to me at this point, doesn't really scare me. But does concern me a bit.
I've also noticed that I usually get "gassy" too, when they start up during the games. Maybe it is really just a lot of adrenaline and nerves from playing hockey again after 10 years.
Aside from all of that, I've averaged 2 goals, and 3 assists per game so .. they aren't holding me back too much ;).
I'll have to look into these arrhythmia specialists who focus on athletes.
I also agree on the Toprol, I have a slow resting heart rate as it is.. and I think Toprol makes it harder for my heart rate to get up to where it should be during exercise. Maybe that is part of the problem too?
I can't add a whole lot more here, but I can tell you if you had HCM, you'd have a hard time playing sports like you do! Go have fun!
Hi! I am so sorry about these problems as I have been experiencing some of the same things you experience. I don't have any PVC's or PVA's, but I do get horrible palpitations and shortness of breath with these quick movements. I play college soccer, and whenever I sprint and then stop, it's like I've just sprinted 18 miles consecutively...it's ridiculous and extremely detrimental as you might imagine. I'm sorry I can't offer much help to you, but I was just wondering if you could tell me of any of these athlete-specialized cardiologists in Colorado. I would really love to see a doctor with a lot of experience with athletes. How do I go about finding these guys? Thanks!
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