Matters of the Heart

What if you woke up one day, and you could no longer do the thing that makes you get out of bed every day?  Your mind is still there, and you have the desire... but your body won't allow you to.  What if you could still do the thing that you live for, but you cause yourself harm in the process?  What if you could drop dead at any moment, and if you continue with your current lifestyle... you might hasten that process?  Would you give up your dream for an extra few years?  How would your quality of life change without the ability to live your dream? 

These are questions that I've contemplated over the last couple of weeks.  Since I developed an arrhythmia.  An arrhythmia is an abnormal electrical rhythm in the heart.  Normally the heart beat arises from the SA (sinoatrial) node.  The electrical pathway depolarizes the atria which contract and then the ventricles which also contract, producing the normal Lub-Dub sound of the heart beat.  The abnormal rhythm can arise from anywhere in the heart muscle, and depending on it's electrical pathway through the heart muscle, can interrupt your normal heart beat. 

An arrhythmia is not a heart murmur.  An arrhythmia does not have to be associated with any underlying disease of the heart muscle, valves or coronary arteries.  There are many types of arrhythmias.  Atrial fibrillation.  Premature atrial or ventricular contractions.  Atrial or ventricular tachycardia.  Ventricular fibrillation.  And others that are more specific to certain illnesses or heart problems. 

My arrhythmia started with premature contractions.  I noticed one day during a swim workout that my heart beat was very erratic.  Normally, one does not "feel" their heart beating.  Even when your heart rate is up, you might feel your pulse in your jugular (or forehead/ limbs/ abdomen/ etc), but you don't feel your heart beating.  I could feel my heart beating irregularly and tightness behind the sternum.  It felt like my heart was pounding on the backside of the sternum.  The premature contractions would interrupt my normal rhythm and then there would be a long pause before my SA node kicked back in.  Eventually the arrhythmia progressed to include runs of tachycardia.  When the arrhythmia stops, I feel nothing again.  No tightness.  No erratic rhythm. 

My resting heart rate is very low.  During the day, with occasional premature contractions, my heart rate would drop into the 40s.  Usually this low of a rate is reserved for when I am lying recumbent in my bed at night.  Generally if I am upright, my rate is closer to 70.  I've not had any shortness of breath, or fainting.  Nothing else has changed.  I still can do my normal workouts, but I have had to stop intervals in the pool and on the spin bike due to onset of the arrhythmia.  Mostly because of my inability to control my heart rate when it starts up.  I can still push hard, but last week I was spinning easy on the bike with little to no resistance and I watched my heart rate jump from 110 to 195, and then when my normal rhythm resumed, it dropped just as quickly to 95.  This is not normal.  If my heart rate is 195, I am maxed out and should be breathing heavy, working hard, sweating.  Not sitting upright on the spin bike at zone 1 effort. 

I visited with a cardiologist a couple of weeks ago.  Unfortunately the visit was quite disappointing for a number of reasons.  First, I was made to wait for 2 1/2 hours because the doctor I was scheduled with was in a procedure.  And then, rather than reschedule my appointment I was then moved to a different doctor.  Keep in mind it's now 4 pm on a Friday afternoon, and the doctor I was reassigned to was squeezing me in on top of his already booked schedule.  So needless to say, he didn't have much interest in what was going on, he wanted me in and out in a hurry.  He didn't ask me any questions pertaining to my level of exercise.  He didn't even ask me to describe the episodes.  He performed a 6- second ECG.  Listened to my heart for an equal amount of time.  And then told me he didn't see anything abnormal.  But to be on the safe side, he wanted to schedule a couple of tests.  He told me it was fine to continue my level of exercise since my performance hadn't suffered due to the arrhythmia.

Given that at the time my abnormal beats were occurring 1-2 times per minute, had he left the ECG running for, say, 60-120 seconds, he might have seen something.  But, what's done is done.  When I left the office I wanted to cry.  Not only did I feel foolish for being so concerned, but I also felt like I had wasted my entire afternoon and 3 minutes of his time.  I was complaining a few days later to my physical therapist (who, by the way, always listens and takes my concerns seriously) and he recommended that I go see a cardiologist that works with athletes.  He gave me the information and I have scheduled an appointment next month to see a new doctor.  One who runs.  I'm hoping he will tell me that everything is fine, and it's nothing to worry about.  And I'm certain that he will.    

I've never taken my health for granted, and now I'm reminded again of how fragile life can be.  One moment you think you've got the world by the balls.  The next thing you know, it's threatening to all disappear.  I've asked myself, if the doctor told me to stop running would I stop?  Would you?