I’ve tried to sum up how I’m feeling and how I should respond to the story so far. Thought you might be interested…
The Theory
I believe that a mature long distance runners heart can be misdiagnosed, and be a concern to most cardiologists after they have seen the unusual results of various tests including ECG’s and 24 hour monitoring. I have been warned about the response long distance runners might receive after this unusual and erratic activity of the heart is observed by the professionals.
The Symptoms
I became a little worried, when relaxing following a hard five mile run, the readings on my pulse oxy meter read 35 beats per minute. I was further alarmed when I spoke to an old Ex long distance runner who explained that my problem was probably Atrial Fibrillation which is apparently common in long distance runners, and he suggested I should get it checked out by a specialist cardiologist. After a short layoff from running due to Gout, and then buttock pain probably caused by piriformis syndrome, I had found it very difficult to return to even short stretches of sustained running, and had to walk often after shortness of breath and severely tired legs had ground me down. Walking while on a scheduled training run is something I have resisted doing for over forty years of running except during some marathons and ultra distance endurance events. I’ve always had an irregular and slow heartbeat and it’s got steadily more noticeable after two heart attacks, the first in 2004 and the other in 2014. I’ve also been experiencing extreme tiredness when not running, but wear and tear and a less efficient heart is presumed the most likely cause.
The Probabilities
Because I’ve only just started monitoring my heart I wonder how long I’ve been running with this?
When taking the treadmill test back in 2004 it was shut down prematurely when my heart apparently went into distress, after discussing the results with Doctor Payne at DRI, when asked, I explained that there was no chest pain prior to the test been aborted. Is it possible that this unusual rhythm is normal for my heart? Is it a natural response from my body following the heart attack to adapt to the loss of muscle, to find new electrical connections through scar tissue, and produce a network of new arteries, which I have been told, the heart will do to try and restore the demands made upon it in the future, especially following a regular exercise routine.
Could they have witnessed the same results as Doctor Mercer did, and they have both panicked not being used to seeing the normal functioning of a long distance runners heart, especially one that has recovered from two heart attacks. Remember the absence of chest pain following the premature shutdown of the treadmill.
The Facts
After performing an ECG at my first consultation, Doctor Mercer concluded from the graph that my heart was adding extra irregular beats and this could explain the extremely low heart rate that I had experienced. He believed my heart could have been beating at twice the rate but the pulse oxy meter would not necessarily be able to read the extra beats, and besides, it was reading the pulse at the end of my arm, and it would not necessarily be a good representation of what the heart was doing. It was decided that a 24 hour monitor and an ultra sound investigation would be the next step.
Meanwhile I had taken delivery of a heart rate monitor with chest strap, apparently a more accurate way of measuring the heart rate, and following my first run using it, I was surprised and shocked to find that after only just a few hundred yards of my early morning run it had leaped to 163 beats per minute, where it remained for about three quarters of a mile before I was forced to stop running and walk. I later found that I could run and walk keeping my heart rate within acceptable levels. Acceptable to me anyway. Perhaps the extra beats that Doctor Mercer identified on the ECG were now assisting my heart to supply the oxygen needed by the muscles to sustain the pace, like some kind of a sixth gear or turbo. Could it be that this has been normal for my heart all along. In which case, intervention by drugs, ablation or treatment by mechanical/electrical means would not only be unnecessary, but detrimental to my hearts performance.
The Conclusions
The results of the 24 hour monitor were well outside normal readings and I was told to stop running immediately and was prescribed a beta blocker 2.5mg Bisoprorol, which I took for three days until I found the side effects intolerable probably due to my already normally low blood pressure and heart rate. We discussed the alarming results of the monitor and the suggested course of action to be taken. I was surprised to learn that Doctor Mercer wasn’t too concerned about my very low heart rate, which was the main reason for my visit, but the seemingly fast and erratic heart rate he had identified from the results of the 24 hour monitor. He suggested ablation, pacemaker, defibrillator, or medication, but due to my intolerance of medication he would probably rule that out. Due to financial constraints it was decided to pass me over to the NHS at the Northern General Hospital Sheffield where further tests would be conducted and courses of treatment advised.
My Overview and Summary
Ablation comprises of preventing unwanted electrical signals in the heart using heat or extreme cold to burn out the scar tissue providing a path for these unwanted signals. It seems a bit hit and miss, with some patients having to return for subsequent procedures or ending up worse off than they were before. Very risky, and there’s no reversing the treatment if anything goes wrong. It all sounds a bit final.
An implanted defibrillator would prevent any kind of strenuous activity as the heart would be shocked into normal operation if the heart rate wandered out of acceptable limits.
A pacemaker would allow exercise, but would probably be used in conjunction with medication.
And calming the heart using medication alone would dumb down the patient and reduce the quality of life.
All these treatments may also impact on the future ability to drive.
I might decide that I’m too young and active to accept any of these treatments, and could possibly control my exercise, diet and lifestyle to prevent excessive use of my heart. I will make a decision after considering what the specialists at the Northern General have advised.
I was dropped from my yearly checkup at the arrhythmia clinic because I refused to consider an ablation . They said come back if anything changes in other words my mind :roll:
so I ‘hold on to nurse’ ie my current situation because at least I have some quality of life most of the time for now.
I have heard good reports from those with a pacemaker in my support group. they seem to work very well for suitable patients .
I believe the time has come to re-evaluate my fitness regime, and I still believe that with careful monitoring I can still do an occasional short jog during a walk…
