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Posts Tagged ‘neurocardiogenic syncope

Off Season Training Report and My Achy Breaky Heart

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It’s winter, cold, and dreary here, which means the off season for triathlon and preparing for my 2nd season of racing. I’ve been meaning to do a post about my training, which I’ll cover here, but I had a surprise related to my health just a couple days ago, so I’ll be writing more about that. Skip ahead for that if you want, its probably more interesting than my training, but I’ll get that out of the way first.

Training:
After my last race in August I didn’t take much time off, maybe just a week of less than normal activity, then I jumped right into a running program. I wanted to focus on my running and try to get a bit faster before the weather got bad, then focus on my cycling on the trainer in the winter months and try to maintain any running gains I made. So for September, October, and November I worked on increasing my running mileage each week, with a long run on the weekends and doing some interval and pace work mixed in the various runs. The first month went well but I think I did a bit too much too soon as I developed achilles tendinitis (self diagnosed) in my right leg. I had to scale it back a bit for a week then for the rest of the time I dialed back on the intervals and just focused on mileage. Things went well, I did longer (time and distance) runs than I’ve ever done before, and did see gains in my speed and endurance. I did a 5k in the middle of that three month stretch and set a PR in it, then did another 5k at in November where I beat the last PR to set a new one, finally getting under the 7:00/mile mark which has been a challenge to me. To be honest, the course was the flattest course imaginable, but I’ll still count it.

In December I started a program to focus on cycling. The program is for all three disciplines, but I’m prioritizing the cycling aspect and doing the running as maintenance and scaling back where it might conflict with getting a good bike session in. That has been going well but I am not yet to my first test to see how much I’ve improved, and just had a little set back, so whether I’ve made progress is yet to be seen.

I’ve also been swimming consistently and feel like I’m making small gains in the water. It is still by far my weakest area and I’m doing the Slowtwitch Guppy Challenge to try to improve over the winter. Time will tell…

The Health Situation:
So on Monday, the day after Christmas, I went to the pool to do my workout. I had just finished an easy 6x50m warm up and was standing in the shallow end when I started feeling light headed. I turned to hold on to the wall but just passed out before I got to it, falling into the water. Next thing I knew there was a person holding on to each of my arms and another on the deck of the pool holding on to me and asking if I was alright and knew where I was. I am AMAZED at how fast people reacted, I was only out and in the water for a second before the life guards got to me. It only took a few moments before I felt alert and normal but they understandably had to call an ambulance. The ambulance came and checked me out, including doing an EKG, which turned out to be very abnormal, so off to the hospital I went.

In the ER I had an echocardiogram and other tests that showed my heart wasn’t working normally. In the doctor’s words, I have “a bizarrely abnormal EKG.” My heart is also much thicker than normal, though the doctors thought this was due to me being an athlete, which was confirmed later. It was very healthy, as in no blockages, build up, or anything like that, but because it was functioning weird, and since I had passed out while swimming for no apparent reason, they didn’t want to let me go.

This has no relevance to anything, but in the ER I was treated by a doctor named Dr. Skull. Not sure on the spelling of his name but that’s how it was pronounced – how cool a name is that for a doctor!?

Anyway, I was admitted and put on an observation floor with a heart monitor hooked up and had a barrage of tests done over the rest of the day and through Tuesday. I don’t remember all of the tests, but I did have a heart catheterization, had my vitals, heart rate, and blood pressure checked a lot, and a ton of blood drawn. My arms look like pin cushions now. The EKG remained weird but everything else was really good. I think I was interesting for the doctors and nurses since I’m in good shape, relatively young (35), but having these problems. And I felt fine and normal the whole time I was in there; I just wanted to get up and move around, and it felt silly even being there, but I was pretty much confined to the bed.

Another funny thing: I have a low resting heart rate due to being in good shape. It usually settles in the low 50’s, but being sedentary like that in the hospital bed it would often drop into the 40’s. This caused some concern at first with the medical folks until they realized it was my normal, and the hospital equipment by default set off alarms when the HR would drop below 50, so that was interesting at first. Apparently when I sleep it drops down into the 30’s.

On Wednesday I had two tests planned: a treadmill stress test and another test whose name escapes me, but it is similar to a cardiac catheterization but tests the electrical activity of the heart, not the “plumbing.” The stress test went well, I pushed it hard on the treadmill and lasted about 21 minutes until they stopped it. I think I could have gone slightly longer but they assured me it was a good test. After the “stress” portion of the test the treadmill goes to a cool down mode where it drops to 0% incline and just 1 mph, which is a very very slow walk. I was walking slowly for about 1 minute when all of a sudden I started feeling light headed and before I could think to say anything, BAM, I passed out again. The two people administering the test were very quick to respond but it happened so fast that they couldn’t catch me and I hit my neck hard on the treadmill in front of me. I came to again very quickly, they helped me to the bed, and I felt normal in just a minute or two. It was basically just like what happened in the pool: I had been exercising, stopped to rest, passed out, then recovered right away. The guy administering the test looked at all the data and saw that in the minute where I was cooling down my heart rate dropped from the 170’s down the whole way into the 30’s! The heart doctor came in right away, reviewed everything, and cancelled the other test that was scheduled since he thought he had everything figured out.

A bit later after some more review and internal discussion, they let me know that I have Vasovagal Syncope (aka Neurocardiogenic Syncope) which basically means that after strenuous activity my blood vessels open too much and heart slows down too much so that my brain doesn’t get enough blood flow, hence the blackouts. There’s definitely a better explanation for it, but that’s me putting it into simple terms. Why it just started happening now is a bit of a guess, but they think it was the perfect mix of poor nutrition, being dehydrated, and it being hot in the pool. The biggest risk is that I might hit my head or hurt myself when fainting. Thankfully, it’s pretty easy to treat; I have to take in a lot more sodium and make sure to stay hydrated. I also have to ease back into exercising and watch myself, but I should be free to workout like I always have and my racing days should be far from over.

One other interesting thing was that my heart activity normalized as I was doing the stress test. This apparently is somewhat common in athletes; the EKG looks abnormal at rest but as it increases under stress it looks normal. So everything looks good from the heart front.

All in all, everything turned out very well, things could have been much worse, I’m very blessed to not have had a more serious accident in the pool, and can’t thank the people that helped me enough. I’m looking forward to getting back to it!

Thanks a lot for reading, Merry Christmas, and Happy New Year!

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Written by Jim

December 29, 2016 at 6:32 pm