Anyone else have chest discomfort for weeks AFTER arythmia?

Every cardiologist tells me the pain is in my head.

Endurance athlete. I exercise very hard without problems for years at a time.

Every few years I'll have an episode with some atrial ectopy usually triggered by exercise with lack of sleep and crippling psychological stress.

Age 24 I had about 30 seconds of atrial flutter.

Age 28 aflutter for an hour.

Age 38 afib for 2 hours

After each of these episodes I had several weeks where I had a constant dull ache in my heart even though I had no rhythm disturbances.

If I tried to exercise I noticed that things really didn't feel right and the ache would be worse hours after the completion of exercise.

After resting for two or three months I would be back to normal with no pain.

There's this idea that once you're out of arrhythmia you should be back to normal. All of my testing is always been normal and I've been told it's just anxiety or in my head. But it seems to be pretty reliably reproducible.

I normally swim 2 miles without difficulty and during my swim the other day I had a few seconds of palpitations. I'm in sinus rhythm but since then that familiar ache is back.

My theory is that there's certain changes that happen before or as a result of the arrhythmia that result in non ischemic heart pain. And that there may also be some degree of subclinical cardiomyopathy that occurs in response to the arrhythmia.

Has anybody else noticed that after an episode of arrhythmia resolves they are left with days or even weeks of chest pain and poor cardiac function that slowly reverses over time?



Edited 1 time(s). Last edit at 12/13/2023 05:11AM by runner114.

The attending physicians and nurses ask me every time if I feel pain. Nope. Well...what DO you feel? A thumping in my left chest wall. Nothing else? Some anxiety, occasionally a little huffy and puffy, but not much else.

My own AF came on inside of the last 2 km of a maintenance run, well before COVID. It was finally deemed to be heart irritability due to severe obstructive apnea during sleep. I'd like to say things got better with CPAP therapy, and for nearly three years it was pretty darned good, but then the AF began to gain ground on me, excellent, enviably good, CPAP therapy consistently notwithstanding.

I could see how some or all of the sensation might be in your head, but I somehow doubt that it is entirely. Each one of us is different in how we sense AF, how we deal with it emotionally, how we try to keep it at arms length with concoctions, routines, therapies, herbs, exercise, refraining from exercise, stopping all caffeine and theobromine sources, etc. I don't know that a spasm can happen, or even if it could be sensed, in the heart or its adjacent major blood vessels, but maybe this is what you sense. Or you tighten connective tissue or muscles or ligaments in the area as part of your neurological response.....? It gets painful like when the muscle at the base of your pinkie goes into slow spasms and you feel burning pain.

I am not discounting what you are feeling, but with my over 200 documented episodes of afib, the second an episode ended, I felt and was functioning 100 normal. I never had any sense that there was a carryover from an episode. Certainly - never any pain.

How fast is your flutter? When I used to have Afib/Flutter with high ventricular rates, my chest would ache or feel beat up for a day or two and then it would go away. I did not experience this once I was on medications that kept the rate down.

You said: "I exercise very hard without problems for years at a time."

It sounds to me like you "do" have problems...Everybody's body is different. Although "you" want to exercise "very hard" maybe your heart does not want to exercise that hard. Reasonable proposition? Much afib is from overdoing. Maybe consider pulling your intensity back 25% and see if that changes your symptoms/problems... at 70 with 17 years of afib, I speak from experience.
Good luck, Jeff

I have to concur with Daisy's experience. After my Afib episodes stopped, I always felt amazing. After my Atrial Flutter episodes stopped, my heart felt...tired is the best way I can explain it.

I have to wonder, though, if in each of those episodes, you may have experienced a virus that attacked your heart tissue for a few days leaving it sore. Perhaps it could have been the cause of both the Afib/Flutter and the pain. Just a thought.

I know I tend to get Afib or Flutter just prior to getting full-blown symptoms of a virus.

JohnG

Esophageal spasms? They are supposedly rare but I get them. AFAIK all the nerves etc are interwoven in that part of the body. For all I know, if something goes wrong in one of them it can affect the other ones.

I get little arrhythmia sensations after an episode. Early on when I first developed this, I felt in my chest like another one was building up to happen, but the EKG and cardiologist said no, and I didn't get one, but the machines can't reveal how you feel. Only you know that.

In The Body Keeps the Score he talks about over exercise being a feature of some people with trauma histories. I know I've done it but my body doesn't like it so I stay away from it. But I can see its attraction.

Quote
Jeff W
You said: "I exercise very hard without problems for years at a time."

It sounds to me like you "do" have problems...Everybody's body is different. Although "you" want to exercise "very hard" maybe your heart does not want to exercise that hard. Reasonable proposition? Much afib is from overdoing. Maybe consider pulling your intensity back 25% and see if that changes your symptoms/problems... at 70 with 17 years of afib, I speak from experience.
Good luck, Jeff

Chronic endurance exercise was my path to afib 19 years ago, I'm now 68. Here is a thread on the topic from a few years ago.

I quit competing and tried to figure out what I could do without triggering afib. In my case, the product of intensity times duration was my trigger. That is long duration, high intensity was a trigger. Long duration at Zone 2 was fine. Short duration Tabatas were fine. Without taking my serum lactate level all the time, or even wearing a chest strap heart rate monitor, I found that using nasal breathing as a governor (and a Zone 2 proxy) worked for me. I still do fun things, like alpine skiing off piste and leading rock climbs. I just moderated what I do to fit what my body is happy with.

Flutter rate just over 130.

Fib 109.

Not enough to strain me.

But even if I just have a handful of PACs or maybe a 5-second run of ectopy... My chest will ache for a week. Longer the episode the longer the symptoms. The few times I had an arrhythmia for several hours it was months of pain and feeling weak.

Maybe there's some stress cardiomyopathy that occurs and cardiac irritability is the result not the cause?

Severe emotional stress + adrenaline + high heart rate = damage = pain?

Have you had a full cardiac workup including a stress test and echocardiogram? Perhaps even a CTA? I know doctors tend to wave off cardiac problems among people in their 20s, but they shouldn't. If you haven't done a full workup, find a cardiologist who will do one. Experiencing discomfort for that long following some minor tachycardia just isn't normal.

Echo was normal. Was told I had very "athletic looking heart."

Troponin's, inflammatory markers and d-dimers always neg

Didn't have a stress. Biked up a mountain wearing a Zio patch every day after my pain went away and my cardiologist was convinced it couldn't be ischemic looking at the heart rates/EKG.

If it was ischemic... It makes no sense that it wouldn't change with exercise and then only occure for a month at a time every few years.

Somehow the two are connected.

Nitro does nothing. Motrin def does.

I also had covid each time about a week before my two episodes. But it feels like a constant inflammatory dull ache. Like a sore muscle. Less noticable with activity, much more so laying down.

I'm going to just ask to do a stress to eliminate it.



Edited 2 time(s). Last edit at 12/15/2023 07:32AM by runner114.

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runner114
Nitro does nothing. Motrin def does.

I also had covid each time about a week before my two episodes. But it feels like a constant inflammatory dull ache. Like a sore muscle. Less noticable with activity, much more so laying down.

I think you have an answer there. COVID is known to cause myocarditis, and this has apparently been particularly prominent in young, healthy athletes. That would explain why nitro does nothing but Motrin does and why the sensation feels like a sore muscle. It IS a sore muscle. But by all means do a stress test. Maybe that will reveal it.

My very fit son of 24 got Covid (unvaxed) and got mild pericarditis/myocarditis-like symptoms including ectopic beats occasionally for a few months that have now disappeared.

Also on the painful ectopic beats, I have been getting those occasionally (maybe 5 a year???) since my first ablation in 2017 with one of the doctors where Natale practices. I mentioned it to them and they didn't seem concerned. The pain does seem to coincide with PAC/PVC's, which I usually don't get that often...and around times I'm sick.

I'm currently a patient of Natale, thank you GeorgeN/Carey, and have had one ablation with him (LAA ablated) and have at least one more in the next couple of months to place the new Watchman device. Before my last ablation with Natale, I got a full coronary CT angiography with contrast and it found nothing unusual in the architecture of my heart.

I don't know if this is relevant, but I feel almost everything that my heart does and always have. I feel every run, afib, and atrial flutter episode. I always get chest pain for a week or so after ablations (I've had three now), and I get those occasional painful ectopic beats. Heck, I can estimate within about 5 how high my systolic is at any given time by how my heart feels.

JohnG

I'm going to assume you have a structurally sound heart and a fairly recent echo. Unlike some who have posted, every afib or flutter episode takes a lot out of me and I'm not back to my pre-episode self for days or weeks. For me, episodes often triggers GERD/heartburn which can present with chest discomfort. Not saying that's the case with you, but if an antacid relieves the pain, then that could be it. I've ended up on PPI's because of this as GERD is not only a sympton of my episodes, but a trigger. Another trigger for my GERD is exercise and you did mention that also can cause your discomfort.

Jim