New to forum - any help/advice please

Hi all,

I must admit I do feel a tad humbled by all of the expert knowledge and information on this fantastic forum, but here’s my first post to hopefully tap into that expertise for some general advice please.

I’m off to the docs this coming Monday 26th Aug for a follow-up chat on my general heart health. My story so far is best described as follows…51yr old male, always fit and active, competitive volleyball, recreational running, cycling, static rowing etc, low resting heart rate. I had experienced the odd ectopic beats come and go over the preceding years, but my first ‘episode’ that caused me to seek medical advice occurred in March 2017 - first night on a ski trip, early start, late night, alcohol, altitude. Woke up in the middle of the night with racing/irregular heartbeat, sat up most of the night, felt a bit better the next day, and pretty much got on with my holiday.

The associated medical intervention then led to a Holter monitor, ECG, heart scan (ultrasound) and gastroscopy. Results and general conclusion from cardiologist in around Sep 2017 was enlarged right atrium and the palpitations were what he described as an ‘inconvenience’. He suggested I take bisoprolol, but after a bit of discussion I chose not to.

Since then, my symptoms have gradually got worse across 2 broad themes.….

A few similar episodes of waking up in the morning with racing/irregular heartbeat which I managed to associate with exercising. I now wear a Garmin heart rate monitor, so can see a spike in heart rate circa 3am/4am which has taken around 36/48 hours to calm down. However I’ve experienced 4 similar episodes in the last 2 weeks which has coincided with a period of rest from exercising. With the last episode on Sunday, I went for a gentle bike ride which seemed to settle things down quicker.

Secondly, I’m experiencing more frequent bouts of rapid/irregular heartbeat almost on a daily basis, most noticeable in the evening, going to bed and waking in the morning. A common theme with these seems to be a correlation with inhaling. I’m aware of RSA but this feels much more marked than my interpretation of RSA, it feels more like my above symptoms. Furthermore, even when they are not present, I’m actually able to initiate said rapid/irregular heartbeats with a full lung and further slow inhaling, or tensing my diaphragm.

The only other point of note is that over the past 20 years, I have regularly experienced what I have generally associated as over-training/over-reaching, with flu-like symptoms/jitters which may or may not be related to what I’m experiencing now. These were often triggered without the intensity of exercise I’d expect, even a hard days gardening could trigger it. With current heart health, I’ve slowed things down significantly so less marked.

So thanks for reading my story, any help/advice most welcome e.g.

- Are these recent symptoms classic Vagal AF?
- Any thought on my inhaling related symptoms
- Where next, what follow-up tests would be recommended (I’m reluctant to take meds until I know exactly what I’m dealing with)
- Any thoughts/advice on exercise duration/intensity (I regularly commute to work on my bike)

Thanks in advance

Brian



Edited 2 time(s). Last edit at 08/20/2019 12:35PM by briar.

Possibly vagal from what you describe.

I’d recommend you get a Kardia Monitor and document the episodes so you know what’s going on. Skip the subscription service that they want to sell you and just print copies straight away that you want to keep.

I would go back and get more precise details from your 1st Holter Monitor, and do another one. That will definatively tell you what is going on. Sounds like PAC's with bouts of Tachycardia. Diagnose before treating. Sounds like your Dr. did not give you the details of what the Holter Monitor results were back in 2017. Maybe start by getting the report through medical records if you don't already have it.

Hi Brian,

- Are these recent symptoms classic Vagal AF?
Sounds pretty vagal to me.

- Any thought on my inhaling related symptoms
Also vagal

- Where next, what follow-up tests would be recommended (I’m reluctant to take meds until I know exactly what I’m dealing with)
a beta blocker, like bisoprolol, could make your vagal triggers more likely to happen. Bisoprolol could be appropriate during an episode to control rate, if it is high and sustained.

- Any thoughts/advice on exercise duration/intensity (I regularly commute to work on my bike)
Endurance exercise, especially, can lead to vagal afib. How much is too much is certainly individual. For me, it is the product of intensity times duration. Hence a short, high intensity session, like a Tabata is OK. Long duration higher intensity is not OK for me. Long duration, low to moderate intensity is OK for me. You may need to detrain and see what happens. If your frequency of afib responds, then you can add intensity and duration back in to see what your limit is.

Again in my experience, consuming magnesium has made a huge difference. I do it to near bowel tolerance, which is very high for me (1.5 to >5 g/day). Exercise does deplete magnesium. In my case, chronic fitness led to my first episode at age 49, 15 years ago. My ticket to relative afib remission has included these elements:

- detraining from endurance training & competition. I remain in excellent condition, but I now think about minimum effective dose. I also have a subjective level of endurance activity I try not to exceed. As mentioned, it is the product of time and intensity for me.
- electrolytes, as mentioned, I take magnesium supplements to bowel tolerance, I put 4 g (2 tsp) of potassium citrate powder in a liter of water and drink over the day and also consum 4 g/day of taurine. I limit calcium intake - no supplements, no dairy.

I concur with Anti-Fib that a holter, is a good idea. A Kardia device is also a good idea, but you'd like to know what is happening in your sleep.

Hope this helps.

George