Potential heart issues with IMMT looming
Posted this over on ST as well because I'm a masochist. 
44 year old male. Let's call me a FOMOP triathlete (sub-11 IM, sub-5 HIM, 2:20-ish Oly). Top 10-20% depending on the race.
Done 5 IMs, 10 HIMs, several Oly and sprint races.6'0" tall and in excellent shape. Only medical issues are seasonal allergies and exercise induced asthma. My typical walk around weight is 170-ish. Typical race weight is 160-ish.
This year has been tough. I had a bout with epididymitis earlier this year that took about 2.5 months to clear up. It ruined my early season as I had to DNS the Texas 70.3, and an Oly race that were both in April. I was also registered for IMCdA but transferred out of that race and into IMC because I couldn't start training until late-April.
I had my FTP as high as 303 in either 2011 or 2012 but have basically just done IM training ever since so my FTP normally hovers around 270 when in peak IM shape. I rode both IMC and IMFL at 200 watts last year and had my best IM runs in each race. I normally train from Jan-Nov each year.
I just felt off as soon as I started training this year. Power, speed, etc. just weren't where they were the past couple of years, especially on the bike which is normally my strongest discipline. I initially chalked it up to starting 3.5 months late in my training. The power still wasn't coming around so I then chalked it up to it being 100 degrees out (I live in the Houston area). The power just never came around even when I hit peak (or near peak) shape a few weeks back. Last year I was busting out 4.5 hour rides during the summer at 210 watts and this year I was struggling to hit 175 watts. My training was otherwise excellent despite not being as "powerful" as seasons past. Very consistent and put in the time.
The one thing I noticed was that my blood pressure had become low. Not super low but around 100/65... which is about 10 units lower for each number than usual. I was also having a lot of issues with lightheadedness and dizziness, which I assumed was due to the low blood pressure. I never fainted or blacked out but came close a couple of times both right after a long training day and at random times.
I don't think I experienced any chest tightness or other perceived heart issues but I guess it's hard to tell that from asthma.
Fast forward to IMC this past weekend. I DNF'd about 6 miles into the run after my leg cramped up around mile 80 of the bike and kept seizing up on the run. I felt "off" on the bike even before the cramping issues. They check your vitals in the med tent and the doc was somewhat concerned about my blood pressure, heart rate and heartbeat. My blood pressure was like 92/56, my pulse was 38 (resting is normally 48-55 when I'm in peak shape) and so faint he had to measure it with a machine, and my heartbeat was somewhat irregular. He explained that isn't entirely uncommon after several hours of exertion but this was also about 90 minutes after I stopped "running." He asked me a series of questions... Do I get lightheaded, have I ever been diagnosed with an irregular heartbeat, etc. I have a full physical done every two years for my job (EKG, blood work, hearing, vision, etc. with the treadmill stress test every four years). My last treadmill stress test showed a minor irregularity in my heartbeat but the doc wasn't super concerned but told me to just pay attention to it. The IMC med tent doc advised me to go see my doc when I got home.
Today I went and saw my doc. Exam, EKG and blood work. Blood work obviously not back yet but the EKG revealed some issues that the doc would consider minor if I were your average lazy, American fatass but I'm not. He wants me to see a cardiologist so I can get more advanced testing (echocardiogram, stress test, etc.). Makes sense.
My issue is I'm registered for Ironman Mont-Tremblant on August 17th. Brother and sister doing this as their first IM race. I can't get a cardiologist appointment in time before the race (I'm going to work some connections to see if I can get a an earlier appointment somehow). I most certainly want to make the most educated decision I can. Odds are the testing will comeback as nothing major but it also might not.
So my thought process is something like this:
- Don't do the race and not risk something going wrong with my ticker.
- Do the race because odds are nothing is really wrong and I'd feel like an asshole bailing on the race and finding out after that my ticker is perfectly fine.
- People will say you can always do another IM race so why risk it (agreed) but I'm pretty much done with full IM racing so there's not another race.
- I'm pissed my season has been a complete bust. Bailing on IMMT would make me 0-5 for this year.
- Going to Mont-Tremblant regardless of whether I race or not. We have a 10-day vacation planned around it.
Mostly thinking outloud here more than seeking advice but whatever words are welcome. Obviously doing a race isn't worth potentially risking my health/life and I really want to have the testing done before carrying on. It's the only smart thing to do. Just wish I had more time.
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Comments
Bob,
Don't push it. Until you can get a complete work up. Your heart rate under stress of 38 bpm concerns me and it was irregular with a low blood pressure. That's nothing to take lightly. Please be a good sherpa and plan to fight another day. If you have any other periods of dizziness please go to your doctor or E.R.
Your family is going to want you there safe. We all do.
I
Heart issues have weighed on me ever since the Chris G incident a couple of years ago. Not that I had any issues per se but just the thought of having a ticking time bomb in my chest scares the crap out of me. He had no apparent signs of any trouble and the worst thing imaginable happened. Now I have some issues so I'm certainly not taking this lightly.
You would think in a city of nearly 7 million with one of the most prominent medical districts in the country that I could get a cardiology appointment quick but that's not the case. Gonna work on that today. Regardless, TriBike Transport picks up my bike next Thursday so that's my cutoff date. I gotta know something by then (which is highly unlikely) or I gotta bail on MT.
Ditto to Tim et al.
Good luck
It sucks but I've come to terms with yet another shit sandwich that 2014 has been serving me.
glad you are at least coming to tremblant.
generally agree with what folks are saying.
maybe get the echocardiogram done before the cardiology appointment. call them and see if that can happen. like get the echo done tomorrow. lots of useful info right there. rule out obvious cardiomyopathy of some sort. etc.
A lot of out-of-state docs (like Robin) suggested getting the echo prior but that's apparently not how things work around here.
Bob,
I am going through a similar (cardiac related) but different (high HR rather than low) issue and I can only agree with the sentiments of the rest of the comments. My workup has been completely negative as far as identifying a cause and I am having a hard time making it happen when I have a monitor on so they can see exactly what is going on. Take your time and get the answer and consult with your cardiologist on your subsequent training/racing plans. BTW, get a cardiologist that exercises not some fat old dude who never gets off of the couch. You would be surprised in the difference in their approach. I've had both.
Had my stress test today. Heart rate monitor I wore over the weekend and stress today today showed no irregularities and my heart is beating perfectly fine. Tomorrow is the echocardiogram. Cardiologist said everything is perfect so far and assuming the echo is fine I'm all clear from a heart standpoint. My blood pressure has returned back to normal. Blood work normal as well.
The cardiologist seems to think I dug myself into some fatigue, dehydration, and nutritional rut and didn't realize it until it started to have an effect on my body.
I'm sure I'm gonna butcher some of the medical mumbo jumbo but after nearly two months of a bunch of tests I have been given an all clear. My heart is in perfect condition and functioning normally. So the good news is there's nothing wrong with my ticker.
The issues I have are:
1. Vasovagal Syncope
2. Bradycardia
Neither of these things presents a serious problem unless one has an underlying cardiac issue... which I thankfully do not. So I won't be dropping dead from a heart attack any time soon.
All humans have some level of vasovagal syncope as it's our body's natural response to certain things (like standing up really quickly after lying down or sitting for a period of time). It's that lightheadedness or dizziness felt due to a quick drop in blood pressure and heart rate. I have somehow developed a hypersensitivity to that response. My response is more severe than most people's response. I get dizzy and lightheaded more easily than most or pass out in a hotel elevator after being in the hot tub easier than most. :-)
Bradycardia is basically a slower than normal heart rate which often brings with it lower than normal blood pressure. Just about all endurance athletes have some level of bradycardia (and an associated largening of the heart) because the heart is a muscle and all that cardio works out that muscle.
So you can see why I'm having some issues because my heart rate and blood pressure are low to begin with so it doesn't take much to trigger my already sensitive vasovagal response.
The docs also believe my body just sort of wore down after all the training I've done over the last two years. I trained for six full Ironman races in the last two years, the majority of which in 90-100 degree heat. Needless to say I'm taking a break from full Ironman races for awhile and altering my training philosophy to allow for more recovery. No more 11 hour long races. I'll "just" stick to 5 hour long races. :-)
So the docs suggested I just be mindful of my issues and be careful of the triggers that may cause me problems. Stay well hydrated and know the signs.