I'm not a doctor but…
Cycling injury, recovery and health issues.
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I''m sure this subject has been done before so my apologies if it has.
I'll be interested to know if anyone out there has had a similiar experience to me. By way of background I'm 50 years old and I commute to work. It's about a 40k round trip. I also might do a long ride on the weekend so nowadays I'm averaging around 250k's a week. At the start of the year I was averaging close to 400k a week, which included a couple nights a week at the Velodrome. Well, some time back I went to the docs when I had the flu and as part of what they always do she took my pulse and blood pressure. She made some comment on my pulse being low (around 40 bpm) and of course I'm thinking and I'm telling the Doc that it must be because I'm this super fit 50 y.o bike riding athlete. To cut a long story short I was asked to wear a Holter monitor and overnight my pulse registered only 28 bpm. I was referred to the Cardio and apparently it's Bradycardia. If I ticked a couple of more boxes I would be in the frame for a pacemaker. The Cardio suggested cutting back on excercise, which I have done and I'm not getting dizzy anymore when I get up quick from sitting down. When I was going to the Velodrome and really pushing myself I found that getting up quick around the house or at work would see me getting dizzy.
During my regular commute my heart rate averages around 100 bpm. with a top of around 125bpm and a low of around 70bpm. This may sound like it's a casual free and easy ride in but I am generally pushing it all the way. Not many people pass me. Occasionally when someone does pass me I step up a bit and try and keep up with them. This is where the problems begin. I've noticed that during these times, on occasions, my heart rate blows out to like 250 to 255 bpm. I usually give up the chase at that point and am forced to really take it easy. I'm worried that this is causing damage to my heart in some way. It doesen't take too long and I'm back around the average bpm but I feel like this is so unusual. i.e. generally low heart rate, with difficulty going over 125bpm and then on occasion spiking to 250bpm when trying to keep up with super fast young riders.
Any comments and suggestions much appreciated.
Hmm - you really need to follow cardiologist advice, get more tests done and maybe get a second opinion.
Have they done any stress tests on you yet? The heart spiking to over 200 from low base does not sound normal.
Is it possible the heart rate monitor is reading double for some reason (have you checked your pulse old fashion way?).
Could be an unusual rhythm that confuses it (also concerning).
It seems odd that it jumps so high. Is 250 really high? Especially from such a low rate?
How reliable is your HRM?
I know that my garmin strap HRM sometimes shows these short spikes that are ridiculously high and are false readings. Not sure if its static from my shirts, bad connection, hairy chest, whatever?
I'm not doubting your stats at all, just questioning your equipment.
In a case like this never ever take Internet advice. Only take the advice of a specialist / cardiologist.
You can get a GP to refer you, but you already know that.
I would have genuine concerns if my rate was getting up to 255, but again, I'm just going on the fact that I have turned myself inside out and never cracked 190 bpm.
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Thanks Harmonix, I questioned the HRM myself and even dismissed it as a fault the first couple of times I saw it. But I believe it's an actual reflection of the heart rate now that it happens with consistency.
When I was at the Cardio he didn't want to do the stress test because he was not confident he could get my heart to 140 bpm. That's apparently the zone they need me to be at to gauge properly.
the 250 spike has happened too consistently to dismiss. I thought something was wrong with the HRM too the first couple of times. That's a good idea re take pulse the old fashioned way. I will do that next time. When I get to that stage though I can barely lift my head up.
Thanks for your comment
I hope for your sake it is a dodgy hrm, get yourself checked out. If you have no problem get a new hrm strap I used to get incredible spikes, usually when I stood up,on pedals it was my shirt rubbing on dodgy hrm strap creating dodgy reading of 200 plus.... But get checked out
I had something similar. HR would suddenly shoot to round 250 or so.
Sent for stress test and diagnosed with tachycardia.
Went off to the electro physiologist for possible ablation as it was thought to be super ventricular tachycardia.
Turned out to be exercise induced multifocal atrial tachycardia.
I was advised to not ride or do any strenuous exercise again.
Nothing could be done except some medication.
I didn't take kindly to the advice and kept riding but These days I have to take it easy and not push. The meds hold my HR at about 120 most of the time but I have to keep an eye on it.
You should try to get it checked out as if it is a tachycardia it could cause some nasty outcomes. Chances are it would be treatable. I was just unlucky.
Other than the jumps to 250, you sound like me. My resting heart rate also low - measured as low as 24, but usually high 20s. I don't know what other signs docs look for, but my doc did not seem concerned and nothing exciting in the ekg.
Anyway, my max is little over 150 - just never goes higher. Hi intensity work is 135-145bpm, and longer endurance stuff maybe 100-120. Seems completely normal in terms of zones, just the max is really quite low. Never had any kind of jumps to higher levels I'm aware of...
Thanks John, I don't know if I could take not being able to ride again. Will definitely get myself checked out but like you I know from here on in I will not be pushing so hard. I saw an interesting article about "V Tach" as it's called. Apparently Greg Walsh pulled the pin on his triathlete career because of Ventricular Tachycardia. Ann Carney had the same thing but opted for a Pacemaker. Here is a link:
http://triathlon.competitor.com/2010/07 ... rdia_10996
I'd question the heart monitor.
If it is tachycardia, at 250 bpm I think you should be acutely aware of it beating furiously. You won't need a gauge to tell you something is different.
And extremely high rates the effectiveness of the heart as a pump falls off to the point that it function resembles less a pump and more a paddle sloshing around in liquid. You should get it checked out asap.
Unchain yourself-Ride a unicycle
Firstly, trust your cardiologist... But question about reducing or giving up cycling.
Late last year I was diagnosed with Super ventricular tachycardia whilst doing an echo stress but this did not explain my dizzyness after standing, after further tests it turned out to be an av node block, two weeks later and I was fitted with a pace maker.
Two months on and I feel great, I'm back on the bike regularly. During this time, my HR monitor kept showing spikes and all sorts, even after the pace maker, but this has all settled down.
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It would be useful for you to either repeat the Holter ambulant ECG monitoring, and wear it while you're on the bike at max chickens. This will show the cardiologist what your heart is actually doing when you think it's going at 250bpm... or have an exercise stress ECG (treadmill or bike) and be pushed to your maximum HR / maximum exertion (again, they're recording your 12-lead ECG the whole time) to see what's really happening.
I second chriscole's suggestion.
ask you doctor to send you off for an "ECG Stress test with ultrasound".
it is a very safe test that takes about 30 minutes and will help identify about 90% of heart problems.
The stress test involves you walking on a treadmill that increases in speed and angle for a period of time, or using an exercise bike. Some places use the bike others use a treadmill. Basically you walk/ cycle for 10-15 minutes and when your heart rate hits about 150 bpm they let you stop. They ultrasound your heart before and immediately after the exercise. If you are fit and want to keep exercising when your heart rate is at 150bpm you can continue until you say enough. This will give you a chance to try and get your heart rate to spike whilst being monitored.
You are connected to some monitoring equipment while undergoing the tests.
The test is done at a cardiologist's office or in hospital, normal at the office tho. Normally a doctor, a cardiologist and several assistants (usually nurses) are in the room while the test is being done. They have shock paddles and nitroglycerine on hand too, just in case you have a heart attack. And they have the ambulance on speed dial
Medicare covers most of the bill, which is about $300 from recollection. Some places bulk bill so it's free from them.
Professional cyclists and athletes have a maximum heart rate of between 170-190 beats per minute, the average person is about 140-160bpm.
Anyone going over 200 beats per minute is at risk of dieing if the heart is kept beating at that pace for any length of time. If your heart is hitting 250 beats per minute, you need to work with your GP and a cardiologist to get this fixed or at least stabilised.
There are pills available (beta-blockers) that reduce your maximum heart rate and prevent it going too high. But your GP and cardiologist will decide whether these should be used for you.
Basically, see you doctor ASAP, and cycle slow and steady until this is resolved.
Do not push yourself until this matter is resolved. The more you push yourself, and the more often your heart rate goes above 200bpm, the more chance of you ending up in a box.
I used to have regular SVT episodes back in the 90s. Visits to cardios etc found no specific cause ( I had ultrasound testing at the time) and I leaned how to end the episodes quickly with a simple stretch and breath control technique. Because no cause was evident I had no specific treatment or medication.
I suggested 'stress/anxiety' as an initial trigger, and the subsequent anxiety feedback loop as being a further factor. This notion was poo-poo-ed by the cardio at the time.
However, medical research subsequently supported my intuition, bearing in mind that my SVTs never occurred during or as a result of exercise.
As time went on and life became less stressful for me the episodes diminished. I had an exercise stress test in about 2005 (I think ) whereupon the testers told me my heart was in fine shape for someone my age (more like a fit and healthy 30yo - I was 50 at the time) and that most people they saw had to be helped off the treadmill after a few minutes !
If yours come on during exercise that is a problem, but consider the issue of other general stressors in your life as a contributing factor.
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Last edited by cyclotaur on Wed Jun 18, 2014 10:12 am, edited 1 time in total.
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"Riding not racing...."
I get HRM spikes to 230+, but I know it's a dodgy HRM. If you can't rule that out, or if you can verify that you're genuinely running at 230+, you need attention.
My legitimate MHR (when the HRM isn't playing up) is up around 190, and I spend quite a bit of time in the 170+ range when I'm laying it down. But random spikes from 140 to 200+ like you're seeing... eeeek.
My RHR is sub-40. That is, by definition, bradycardia, which just means a low heart rate. But I don't get any other symptoms - no dizziness or numbness or cold extremities or any other circulatory issues.
I told one GP about my RHR, and he said that in absence of other symptoms, it isn't a concern at all. I mentioned it to another GP and he was very concerned - if it "ever goes below 40 again" he wants to get tests done. The first GP is more experienced, is a distance runner and has a RHR of 41; the second is fresh out of school and looks like he hasn't done a whole lot of exercise in his life. I know which opinion I put more faith in
You only get one heart, and you don't get many chances to fix it if it breaks down in service. Get yourself checked and fixed.
Generally, my heart rate is very low. RHR is around 44 so generally it's a Bradycardia situation, however, without all the other symptoms the Cardiologist was not that concerned. While in his office he was pondering whether to do a stress test but he decided against it for some reason. I think he felt that I would not get to the required 140 bpm. I was quite willing to do it.
Nowadays I pay very close attention to my heart rate. The spikes can happen very quickly. As I mentioned before my average HR is 100 with a bandwith of between 70 to 125. Today, riding home a couple of riders were drafting me so there was a little pressure to maintain pace. Very quickly it punched up to around 200. Instantly I backed off. A few more seconds and I know that I would be around mid 250's. Anyway, I will be seeing the Cardio again in the near future and will definitely be pushing for the stress test.
The aim of en exercise stress test is to get you to (or very close to) your maximum heart rate, which if you're under 80 years old is going to be a lot faster than 140bpm. There are several formulas out there for calculating/estimating what your maximum heart rate "should" be, but basically they're all very rough and only useful in a statistical (whole population) sense. The simplest one is 220-age, which most people naively quote. However, I'm 39 and in real life max out at around 200bpm, rather than 180 (which for me is my maximum sustainable work rate during xc ski racing, riding, etc).
It is not possible for you to reach heart rates faster than around 200bpm and still be in sinus rhythm (i.e. an electrically normal heart rhythm). If you're legitimately getting to HRs > 200bpm reproducibly, then there's an arrhythmia involved. If the cardiologist is happy with your resting ECG (no signs of pre-excitation / Wolff-Parkinson-White, long-QT syndrome, etc.) then the only way you'll sort it out is to catch it in the act... Holter monitor while exercising/riding, or an exercise stress ECG.
Beta-blockers may not be a sensible approach if his resting HR is already as low as he suggests.
yeah I know. The OP needs to discuss this and other options with their doctor and cardiologist.
A bit sciency, but useful, if you don't mind digging the Net for the terminology:
In my opinion, the fact that you have symptoms - getting dizzy when standing up, for instance, means that whatever is going on in your heart is significant and should not be ignored. Scaling back on the volume of training seems to have helped, so it could be a good idea to do it on more permanent basis. Things tend to get worse with age, and after fifty it all starts happening in all of us.
Excessively high heart rate does lead to impaired blood flow to the endocardium, the inner part of heart muscle, and with time can lead to partial scarring of this area, or fibrosis. This, in turn, can affect the electrical system of the heart, with unpleasant and possibly dangerous consequences. It may not be a bad idea to find a cardiologist who has experience with athletes.
I haven't broken 180 yet. As a 31 year old I don't know if its because I'm not pushing hard enough or just have a low limit. Above 175 I get pain in the middle of my back over the left side (same side as heart) and feel like I'm about to pass out so guess its close to my theoretical max.
The highest accurate I have seen on my garmin is 187 bpm. I have seen 205 but it was a spot reading... looking at the data it is lower before and after and there was just one 205 so I assume it was a glitch. It's certainly unlikely as I started seeing stars at 187 so I know that is close to my max. Oh yeah, I was 42 at the time.
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I am about the same 48yr old if I get above 180 I am really red lining it, if I see a spike above 200 and I'm not pushing hard I know it's that beloved garmin soft strap doing its thing again
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